What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) (n=3170). Intervention: Pulmonary embolism (PE) vs. AE-COPD without PE. Primary outcome: Prevalence of pulmonary embolism (PE) (95% CI 13.4%-21.3%).

What does this research mean for the field?

Pulmonary embolism occurs in approximately 17.2% of patients with acute exacerbation of COPD and is associated with distinct clinical features, elevated biomarkers, and a significantly increased risk of mortality. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

September 2, 2021Open Access

The prevalence and clinical features of pulmonary embolism in patients with AE-COPD: A meta-analysis and systematic review

Key Result

The pooled prevalence of pulmonary embolism in patients with acute exacerbation of chronic obstructive pulmonary disease was 17.2%, and its presence significantly increased the risk of death (OR 2.23).

Study Design

Type

Meta-Analysis (n=3,170)

Structured PICO

What is the prevalence of pulmonary embolism in patients with AE-COPD, and does it increase the risk of mortality?

Population

3,170 patients with acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) pooled from 17 studies.

Intervention

Presence of pulmonary embolism (PE)

Comparator

AE-COPD patients without pulmonary embolism

Outcome

Prevalence of pulmonary embolism (PE) and deep vein thrombosis (DVT), and risk of fatal outcome

Pulmonary embolism is highly prevalent (17.2%) in patients with acute exacerbation of COPD and is associated with significantly increased mortality, highlighting the need for clinical vigilance.

Limitations

Heterogeneity of the findings was observed among the included studies
The majority of the studies were conducted in Asia, which may introduce regional differences
Possible missed relevant studies despite comprehensive literature search

Abstract

BACKGROUND: The prevalence of pulmonary embolism (PE) in the acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) is highly controversial. We conducted a systematic review and meta-analysis to summarize the epidemiology and characteristics of PE with AE-COPD for current studies. METHODS: We searched the PubMed, EMBASE, Cochrane Library and Web of Science databases for studies published prior to October 21, 2020. Pooled proportions with 95% confidence intervals (95% CIs) were calculated using a random effects model. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals were used as effect measures for dichotomous and continuous variables, respectively. RESULTS: A total of 17 studies involving 3170 patients were included. The prevalence of PE and deep vein thrombosis (DVT) in AE-COPD patients was 17.2% (95% CI: 13.4%-21.3%) and 7.1% (95% CI: 3.7%-11.4%%), respectively. Dyspnea (OR = 6.77, 95% CI: 1.97-23.22), pleuritic chest pain (OR = 3.25, 95% CI: 2.06-5.12), lower limb asymmetry or edema (OR = 2.46, 95% CI:1.51-4.00), higher heart rates (MD = 20.51, 95% CI: 4.95-36.08), longer hospital stays (MD = 3.66, 95% CI: 3.01-4.31) were associated with the PE in the AE-COPD patients. Levels of D-dimer (MD = 1.51, 95% CI: 0.80-2.23), WBC counts (MD = 1.42, 95% CI: 0.14-2.70) were significantly higher and levels of PaO2 was lower (MD = -17.20, 95% CI: -33.94- -0.45, P<0.05) in the AE-COPD with PE group. The AE-COPD with PE group had increased risk of fatal outcome than the AE-COPD group (OR = 2.23, 95% CI: 1.43-3.50). CONCLUSIONS: The prevalence of PE during AE-COPD varies considerably among the studies. AE-COPD patients with PE experienced an increased risk of death, especially among the ICU patients. Understanding the potential risk factors for PE may help clinicians identify AE-COPD patients at increased risk of PE. PROSPERO REGISTRATION NUMBER: CRD42021226568.

Ask AI

Helpful

Bookmark

View Full Paper