在因慢性阻塞性肺疾病加重而住院的患者中识别肺栓塞的挑战。

IF 2.2 4区医学 Q3 RESPIRATORY SYSTEM Respiratory Medicine and Research Pub Date : 2024-06-22 DOI:10.1016/j.resmer.2024.101122

Rufang Li , Jie Zeng , DanXiong Sun, Dengyuan Li

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引用次数: 0

摘要

背景：慢性阻塞性肺疾病（COPD）与气流阻塞有关，威胁着全球健康。在慢性阻塞性肺疾病急性加重期（AECOPD）患者住院期间，肺栓塞（PE）的高发病率严重影响了疾病的预后。本研究旨在评估AECOPD患者与AECOPD-PE患者临床数据的差异，并确定PE的相关因素：我们对2018年1月至2021年12月期间的AECOPD患者进行了一项回顾性病例对照研究。由于疑似 PE，所有患者均接受了放射学检查。无 PE 的患者作为对照。临床数据和实验室检查均有记录。采用单变量分析和多变量逻辑回归分析来研究 PE 的独立预测因素。采用接收者操作特征曲线（ROC）评估风险因素对 PE 预测的影响：共纳入 191 例患者进行分析，分为 AECOPD 组（96 例）和 AECOPD-PE 组（95 例）。AECOPD患者与AECOPD合并PE患者的人口统计学特征未发现差异。平均 PO2 和 PCO2 水平、肺功能和超声心动图指标与 PE 无关。与AECOPD患者相比，AECOPD-PE组患者的D-二聚体浓度、简化井评分≥2分的比例以及下肢深静脉血栓（DVT）的发生率明显增加。多变量分析显示，上述三项指标与 PE 的发生密切相关。D-二聚体与下肢深静脉血栓和简化威尔斯评分的AUC值为0.729：结论：D-二聚体、下肢深静脉血栓和简化威尔斯评分≥2与较高的 PE 风险相关，这将有助于提高临床医生对 AECOPD 继发性 PE 的认识。

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The challenges of identifying pulmonary embolism in patients hospitalized for exacerbations of COPD

Background

Chronic obstructive pulmonary disease (COPD) is associated with airflow obstruction that threatens global health. During the hospitalization of patients with acute exacerbations of COPD (AECOPD), the high prevalence of pulmonary embolism (PE) seriously affects the prognosis of disease. This study aims to assess the differences in clinical data between patients with AECOPD and patients with AECOPD-PE, and to identify the relevant factors of PE.

Methods

We performed a retrospective case-control study in AECOPD patients between January 2018 and December 2021. Due to suspected PE, all patients underwent radiological examination. Patients without PE were included as controls. Clinical data and laboratory tests were recorded. Univariate analysis and multivariate logistic regression analysis were used to investigate the independent predictors of PE. Receiver operating characteristics (ROC) curves was performed to evaluate the effect of risk factors on PE prediction.

Results

A total of 191 patients were included for analysis, divided into the AECOPD group (96 cases) and AECOPD-PE group (95 cases). No statistic differences were detected in demographic characteristics between patients with AECOPD and patients with AECOPD and PE. Average PO₂ and PCO₂ levels, lung function, and Echocardiographic indicator were not associated with PE. The concentration of D-dimer, the proportion of simplified wells score ≥ 2, and the incidence rate of lower extremity deep vein thrombosis (DVT) remarkably increased in AECOPD-PE group than AECOPD individuals. At multivariate analysis, the above three indicators were closely relevant to the occurrence of PE. The AUC value for D-dimer combined with lower extremity DVT and Simplified Wells Score was 0.729.

Conclusions

D-dimer, lower extremity DVT, and simplified wells score ≥ 2 were relevant to higher risks of PE, which will help to improve clinicians’ understanding of PE secondary to AECOPD.

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