title: Incidence and impact outcome of pulmonary embolism in critically ill patients with severe exacerbation of chronic obstructive pulmonary diseases.
abstract: OBJECTIVE
  We aimed to determine the incidence and the prognostic impact [mortality and length of intensive care unit (ICU) stay (LOS)] of pulmonary embolism (PE) in critically ill patients with severe acute exacerbation of chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  This is a retrospective study performed during a 5-year period in the ICU of Habib Bourguiba University Hospital (Sfax, Tunisia). All patients with severe acute exacerbation of COPD were included. The diagnosis of PE is confirmed by spiral computed tomography scan showing one or more filling defects or obstruction in the pulmonary artery or its branches.
  
  
  RESULTS
  During the study period, 131 patients with acute exacerbation of COPD were admitted in our ICU. The mean age (±standard deviation) was 68.6 ± 9.2 years, ranging from 39 to 99 years (median: 70 years). During their ICU stay, 23 patients (17.5%) developed PE. The diagnosis was confirmed within 48 h from ICU admission in all cases but one. The comparison between the two groups (with and without PE) showed that they had the same baseline characteristics. However, all PE group developed shock on ICU admission or during ICU stay. Signs of right heart failure were more observed in the PE group. ICU mortality was significantly higher in the PE group (69.5% vs 44%; P = 0.029). In addition, the ICU LOS was significantly higher in the PE group than the PE-free group (P = 0.007). Finally, PE was identified as an independent factor predicting poor outcome [odds ratio = 3.49, 95% CI (1.01-11.1); P = 0.035].
  
  
  CONCLUSIONS
  Our study showed that PE is common in patients with severe COPD exacerbation requiring ICU admission. Moreover, PE was significantly associated with higher mortality and ICU LOS in critically ill patients with severe COPD exacerbation.
authors.affiliation: Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisie.
authors.forename: Mabrouk
authors.initials: M
authors.lastname: Bahloul
authors.affiliation: Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisie.
authors.forename: Anis
authors.initials: A
authors.lastname: Chaari
authors.affiliation: Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisie.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Tounsi
authors.affiliation: Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisie.
authors.forename: Najeh
authors.initials: N
authors.lastname: Baccouche
authors.affiliation: Department of Radiology, CHU Habib Bourguiba, Sfax, Tunisie.
authors.forename: Hanen
authors.initials: H
authors.lastname: Abid
authors.affiliation: Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisie.
authors.forename: Kamilia
authors.initials: K
authors.lastname: Chtara
authors.affiliation: Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisie.
authors.forename: Chokri
authors.initials: C
authors.lastname: Ben Hamida
authors.affiliation: Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisie.
authors.forename: Hatem
authors.initials: H
authors.lastname: Ghadhoune
authors.affiliation: Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisie.
authors.forename: Hassen
authors.initials: H
authors.lastname: Dammak
authors.affiliation: Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisie.
authors.forename: Hedi
authors.initials: H
authors.lastname: Chelly
authors.affiliation: Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisie.
authors.forename: Mounir
authors.initials: M
authors.lastname: Bouaziz
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D016638:Critical Illness; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies
keywords: ICU; chronic obstructive pulmonary disease; outcome; pulmonary embolism