[Chronic obstructive pulmonary disease in patients with acute symptomatic pulmonary embolism].
BACKGROUND
The diagnosis of pulmonary embolism (PE) is often complicated by the presence of chronic obstructive pulmonary disease (COPD). Some studies have suggested that patients with PE and concomitant COPD have a worse prognosis than patients without COPD.


METHODS
Outpatients diagnosed with acute symptomatic PE at a university tertiary care hospital were prospectively included in the study. Clinical characteristics, time between onset of symptoms and diagnosis, and outcome were analyzed according to presence or absence of COPD. The primary endpoint was all-cause deaths at 3 months.


RESULTS
Of 882 patients with a confirmed diagnosis of acute symptomatic PE, 8% (95% confidence interval [CI], 6%-9%) had COPD. Patients with COPD were significantly more likely to have a delay in diagnosis of more than 3 days and to have a low pretest probability of pulmonary embolism according to a standardized clinical score. The total number of deaths during 3 months of follow-up was 128 (14%; 95% CI, 12%-17%). Factors significantly associated with mortality from all causes were a history of cancer or immobilization, systolic blood pressure less than 100mm Hg, and arterial oxyhemoglobin saturation less than 90%. COPD was significantly associated with PE-related death in the logistic regression analysis (relative risk, 2.2; 95% CI, 1.0-5.1).


CONCLUSIONS
Patients with COPD and PE more often have a lower pretest probability and a longer delay in diagnosis of PE. COPD is significantly associated with PE-related death in the 3 months following diagnosis.
Fernández
Carolina
C
Servicio de Neumología, Hospital Ramón y Cajal, Madrid, España.
Jiménez
David
D
De Miguel
Javier
J
Martí
David
D
Díaz
Gema
G
Sueiro
Antonio
A
D000208:Acute Disease; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality; D006470:Hemorrhage / Q000401:mortality; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007022:Hypotension / Q000453:epidemiology; D000860:Hypoxia / Q000453:epidemiology; D007103:Immobilization / Q000009:adverse effects; D007239:Infections / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000453:epidemiology*; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight