Acute Pulmonary Embolism in COPD patients, clinical features and outcomes

Acute exacerbation of Chronic Obstructive Pulmonary Disease (AE-COPD) could be associated with acute episode of Pulmonary Embolism (PE). PE is a cause of morbidity in COPD, but neither the presentation nor the outcome of PE in COPD patients (pts) is well known. The aim of this study was to evaluate COPD pts admitted with acute PE and compare them with AE-COPD pts without PE. An observational study was performed on hospitalized pts in 2015 with the diagnosis of COPD. Of the 106 pts included (69% men, 31% women, 73±11years), we identified 9 pts (8.5%) admitted with PE (9 men, 72±8years), 5 of whom had a history of exacerbations (1 patient GOLD-C, 4pts GOLD-D). One patient had a predisposing factor (immobilization/surgery) for PE, the other PEs were unprovoked events. Chest pain was reported more frequently in pts with PE (44.4%) than in pts without PE (13.4%), whereas increase of sputum was less frequent in PE cases (11.1% vs 59.8%). Subjects with PE showed a statistically significant decrease of PaCO2 (40±7mmHg) than pts without PE (53±21mmHg). NTpro-BNP and d-dimers were similar in both groups (1554 vs 2551pg/mL, 8.6±12.7 vs 0.76±2.28 ug/mL; in pts with PE vs pts without PE, respectively). 12 pts died in first 30 days after the admission, one with PE and 11 pts (10%) without PE. The number of readmissions one year after was similar (0.33±0.5 in PE group vs 0.92±1.2 in non-PE pts). In our small sample, the prevalence of PE observed is slightly inferior than reported in the literature. High index of suspicion is needed in AE-COPD to identify PE due to similar clinical features in both groups. PaCO2 and symptoms merit clinical attention. No differences in mortality and readmissions were observed in both groups.