Prevalence of Pulmonary Embolism Among Patients With COPD Hospitalized With Acutely Worsening Respiratory Symptoms
Prevalence of Pulmonary Embolism Among Patients With COPD Hospitalized With Acutely Worsening Respiratory Symptoms
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DOI：
10.1001/jama.2020.23567
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发表时间：
2021-01-05
影响因子：
120.7
通讯作者：
Leroyer, Christophe
中科院分区：
文献类型：
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作者：
Couturaud, Francis;Bertoletti, Laurent;Leroyer, Christophe
这项横断面研究描述了法国因呼吸道症状急性恶化而住院的 COPD 患者中肺栓塞的患病率，该患病率由统一的诊断算法定义。 重要性 慢性阻塞性肺疾病 (COPD) 和呼吸道症状急性恶化的患者中肺栓塞的患病率仍不确定。目的 确定因呼吸道症状急性恶化而入院的 COPD 患者肺栓塞的患病率。设计、背景和参与者 在 7 家法国医院进行的多中心横断面研究和前瞻性随访。入院48小时内应用基于Geneva评分、D-二聚体水平、螺旋计算机断层肺血管造影加腿部加压超声的预定义肺栓塞诊断算法；所有患者均进行了 3 个月的随访。患者于 2014 年 1 月至 2017 年 5 月期间招募，最终随访日期为 2017 年 8 月 22 日。 暴露 慢性阻塞性肺病 (COPD) 患者呼吸道症状急剧恶化。主要结局和措施 主要结局是入院 48 小时内诊断出肺栓塞。关键的次要结局是入院时被认为没有静脉血栓栓塞且未接受抗凝治疗的患者在为期 3 个月的随访中出现肺栓塞。其他结局包括入院时和随访期间的静脉血栓栓塞（肺栓塞和/或深静脉血栓形成）以及 3 个月死亡率，无论临床上是否怀疑静脉血栓栓塞。结果 在 740 名患者中（平均年龄 68.2 岁 [SD，10.9 岁]；274 名女性 [37.0%]），44 名患者在入院 48 小时内确诊肺栓塞（5.9%；95% CI，4.5%-7.9%）。入院时被认为没有静脉血栓栓塞且未接受抗凝治疗的 670 例患者中，随访期间有 5 例患者发生肺栓塞（0.7%；95% CI，0.3%-1.7%），其中 3 例与肺栓塞相关死亡。 3 个月总体死亡率为 6.8%（740 例中有 50 例；95% CI，5.2%-8.8%）。入院时患有静脉血栓栓塞的患者在随访期间死亡的比例高于入院时未患有静脉血栓栓塞的患者的比例（54 名患者中的 14 名 [25.9%] vs 686 名患者中的 36 名 [5.2%]；风险差异，20.7%，95% CI，10.7%-33.8%；P < .001）。怀疑肺栓塞的患者 (n = 299) 中静脉血栓栓塞的患病率为 11.7% (95% CI, 8.6%-15.9%)，未怀疑肺栓塞的患者 (n = 441) 中静脉血栓栓塞的患病率为 4.3% (95% CI, 2.8%-6.6%)。结论和相关性 在因呼吸道症状急性恶化而入院的慢性阻塞性肺病患者中，使用预定义的诊断算法检测出 5.9% 的患者存在肺栓塞。需要进一步的研究来了解系统性肺栓塞筛查在该患者群体中可能发挥的作用。问题 因呼吸道症状急剧恶化而入院的慢性阻塞性肺病患者中，肺栓塞有多常见？结果 在这项前瞻性随访横断面研究中，使用预定义的肺栓塞诊断算法，纳入了 740 名连续患有慢性阻塞性肺病的患者，其中 5.9% 的患者检测到肺栓塞。含义 在因呼吸道症状急性恶化而入院的慢性阻塞性肺病患者中，使用预定义的诊断算法检测出 5.9% 的患者存在肺栓塞。
This cross-sectional study characterizes the prevalence of pulmonary embolism defined by a uniform diagnostic algorithm in patients in France with COPD hospitalized with acutely worsening respiratory symptoms.Importance The prevalence of pulmonary embolism in patients with chronic obstructive pulmonary disease (COPD) and acutely worsening respiratory symptoms remains uncertain. Objective To determine the prevalence of pulmonary embolism in patients with COPD admitted to the hospital for acutely worsening respiratory symptoms. Design, Setting, and Participants Multicenter cross-sectional study with prospective follow-up conducted in 7 French hospitals. A predefined pulmonary embolism diagnostic algorithm based on Geneva score, D-dimer levels, and spiral computed tomographic pulmonary angiography plus leg compression ultrasound was applied within 48 hours of admission; all patients had 3-month follow-up. Patients were recruited from January 2014 to May 2017 and the final date of follow-up was August 22, 2017. Exposures Acutely worsening respiratory symptoms in patients with COPD. Main Outcomes and Measures The primary outcome was pulmonary embolism diagnosed within 48 hours of admission. Key secondary outcome was pulmonary embolism during a 3-month follow-up among patients deemed not to have venous thromboembolism at admission and who did not receive anticoagulant treatment. Other outcomes were venous thromboembolism (pulmonary embolism and/or deep vein thrombosis) at admission and during follow-up, and 3-month mortality, whether venous thromboembolism was clinically suspected or not. Results Among 740 included patients (mean age, 68.2 years [SD, 10.9 years]; 274 women [37.0%]), pulmonary embolism was confirmed within 48 hours of admission in 44 patients (5.9%; 95% CI, 4.5%-7.9%). Among the 670 patients deemed not to have venous thromboembolism at admission and who did not receive anticoagulation, pulmonary embolism occurred in 5 patients (0.7%; 95% CI, 0.3%-1.7%) during follow-up, including 3 deaths related to pulmonary embolism. The overall 3-month mortality rate was 6.8% (50 of 740; 95% CI, 5.2%-8.8%). The proportion of patients who died during follow-up was higher among those with venous thromboembolism at admission than the proportion of those without it at admission (14 [25.9%] of 54 patients vs 36 [5.2%] of 686; risk difference, 20.7%, 95% CI, 10.7%-33.8%; P < .001). The prevalence of venous thromboembolism was 11.7% (95% CI, 8.6%-15.9%) among patients in whom pulmonary embolism was suspected (n = 299) and was 4.3% (95% CI, 2.8%-6.6%) among those in whom pulmonary embolism was not suspected (n = 441). Conclusions and Relevance Among patients with chronic obstructive pulmonary disease admitted to the hospital with an acute worsening of respiratory symptoms, pulmonary embolism was detected in 5.9% of patients using a predefined diagnostic algorithm. Further research is needed to understand the possible role of systematic screening for pulmonary embolism in this patient population.Question How common is pulmonary embolism among patients with chronic obstructive pulmonary disease who are admitted to the hospital with acutely worsening respiratory symptoms? Findings In this cross-sectional study with prospective follow-up that used a predefined pulmonary embolism diagnostic algorithm and included 740 consecutive patients with chronic obstructive pulmonary disease, pulmonary embolism was detected in 5.9% of patients. Meaning Among patients with chronic obstructive pulmonary disease admitted to the hospital with an acute worsening of respiratory symptoms, pulmonary embolism was detected in 5.9% patients using a predefined diagnostic algorithm.