Chest
Special FeaturePrevalence of Pulmonary Embolism in Acute Exacerbations of COPD: A Systematic Review and Metaanalysis
Section snippets
Data Searches and Study Selection
A comprehensive literature search for English and French articles was conducted using MEDLINE (1949-April 2008), CINAHL (1982-April 2008), and EMBASE (1980-April 2008). Search terms for VTE, which included “pulmonary embolism,” “PE,” “thromboembolism,” or “venous thromboembolism” were combined with those for COPD, which included “COPD,” “COPD exacerbation,” “emphysema,” and “bronchitis.” This process was complemented by hand searching of bibliographies of retrieved articles to find additional
Study Selection
A total of 2,407 articles were identified using the MEDLINE, CINAHL, and Embase search engines; 2,384 articles were excluded because they did not meet the inclusion criteria or were multiple articles from the same cohort. The remaining 23 articles were retrieved for detailed examination. Of these, 11 articles were excluded for the following reasons on further review: (1) they contained a significant selection bias for VTE; (2) they did not employ CT scanning or pulmonary angiography in their
Discussion
The most important finding of our study was the relatively high prevalence of PE among patients who required hospitalization for acute exacerbations of COPD. Overall, one of four COPD patients who were hospitalized and investigated for VTE had objective evidence for PE requiring anticoagulant therapy. While striking, these data should be interpreted cautiously owing to the heterogeneity in the design, the setting, and enrollment criteria among the included studies.
Because symptoms of PE may be
Acknowledgment
The authors wish to thank the three anonymous reviewers whose comments enhanced the quality of this article.
References (21)
- et al.
Mortality by cause for eight regions of the world: Global Burden of Disease Study
Lancet
(1997) - et al.
COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program
Chest
(2005) - et al.
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies
Lancet
(2007) - et al.
The diagnosis of acute pulmonary embolism in patients with chronic obstructive pulmonary disease
Chest
(1992) - et al.
Risk factors of emergency care and admissions in COPD patients with high consumption of health resources
Respir Med
(2004) - et al.
Accuracy of clinical decision rule, d-dimer and spiral computed tomography in patients with malignancy, previous venous thromboembolism, COPD or heart failure and in older patients with suspected pulmonary embolism
J Thromb Haemost
(2006) - et al.
Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER)
Lancet
(1999) - et al.
COPD exacerbations: 2. Aetiology
Thorax
(2006) - et al.
Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease
JAMA
(1995) Acute pulmonary embolism
N Engl J Med
(2008)
Cited by (0)
This project was supported by the Canadian Institutes of Health Research and the Michael Smith Foundation for Health Research.
None of the authors have any conflicts of interest to disclose.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).
- 1
Dr. Sin is a Canada Research Chair in COPD and a senior scholar with the Michael Smith Foundation for Health Research.