Department of Respiratory and Critical Care Medicine, Shengzhou People's Hospital, the First Affiliated Hospital of Zhejiang University Shengzhou Branch, Shengzhou, Zhejiang Province, P.R. China.
Eur Rev Med Pharmacol Sci. 2021 Mar;25(6):2604-2616. doi: 10.26355/eurrev_202103_25424.
The current study aimed to pool data for the prevalence of pulmonary embolism (PE) in acute exacerbation of chronic obstructive pulmonary disease (AE-COPD). We also aimed to assess the risk factors of PE and its impact on the outcomes of AE-COPD.
PubMed, Embase, and CENTRAL databases were searched up to 1st January 2021 for prospective, retrospective, and cross-sectional studies reporting the prevalence of PE in AE-COPD based on computed tomography (CT) data.
Sixteen studies were included. Pooled data of 5035 patients indicated the prevalence of PE in AE-COPD to be 12.9% (95% CI: 8.9%-18.4%). In studies wherein, all patients underwent CT the prevalence was 19.4% (95% CI: 13.4%-27.4%). On the other hand, the prevalence of PE was 7.8% (95% CI: 3.7%-15.7%) in studies where CT was carried out only after screening patients based on study-specific diagnostic protocol. Multiple studies indicated that recent immobilization, increased D-dimer levels, lower limb edema, older age and the concomitant presence of deep vein thrombosis were independent risk factors for PE in AE-COPD. Pooled analysis indicated that PE was associated with a significantly increased risk of mortality (OR: 3.21 95% CI: 1.86, 5.54 I2=52% p<0.0001) and longer ICU/hospital stay (MD: 3.26 95% CI: 1.93, 4.58 I2=0% p<0.00001) in AE-COPD.
The prevalence of PE in AE-COPD is estimated to be 12.9%. This figure, however, varies based on the PE workup protocol. Higher prevalence (19.4%) was noted when all patients underwent CT as compared to when a study-specific diagnostic protocol was followed (7.8%). Recent immobilization, increased D-dimer levels, lower limb edema, older age and the concomitant presence of deep vein thrombosis are important independent risk factors for PE in patients with AE-COPD. Patients diagnosed with PE have increased mortality and longer ICU/hospital stay as compared to non-PE patients.
本研究旨在汇总慢性阻塞性肺疾病急性加重（AE-COPD）患者中肺栓塞（PE）的患病率数据，并评估 PE 的危险因素及其对 AE-COPD 结局的影响。
检索 PubMed、Embase 和 CENTRAL 数据库，纳入截至 2021 年 1 月 1 日基于计算机断层扫描（CT）数据报告 AE-COPD 患者中 PE 患病率的前瞻性、回顾性和横断面研究。
纳入 16 项研究。汇总 5035 例患者的数据显示，AE-COPD 中 PE 的患病率为 12.9%（95%CI：8.9%-18.4%）。所有患者均行 CT 检查的研究中，PE 的患病率为 19.4%（95%CI：13.4%-27.4%）。另一方面，仅根据研究特定的诊断方案对患者进行筛选后行 CT 检查的研究中，PE 的患病率为 7.8%（95%CI：3.7%-15.7%）。多项研究表明，近期制动、D-二聚体水平升高、下肢水肿、年龄较大以及深静脉血栓形成并存是 AE-COPD 中 PE 的独立危险因素。汇总分析表明，PE 与 AE-COPD 患者的死亡率显著升高（OR：3.21，95%CI：1.86，5.54，I2=52%，p<0.0001）和 ICU/住院时间延长（MD：3.26，95%CI：1.93，4.58，I2=0%，p<0.00001）相关。
AE-COPD 患者中 PE 的患病率估计为 12.9%。但这一数字会因 PE 检查方案而有所不同。与采用研究特定的诊断方案（7.8%）相比，所有患者均行 CT 检查时，PE 的患病率更高（19.4%）。近期制动、D-二聚体水平升高、下肢水肿、年龄较大以及深静脉血栓形成并存是 AE-COPD 患者中 PE 的重要独立危险因素。与非 PE 患者相比，PE 患者的死亡率更高，ICU/住院时间更长。
