Diagnosis of pulmonary embolism in patients with acute exacerbations of chronic obstructive pulmonary disease: A cross-sectional study.

Tytuł:: Diagnosis of pulmonary embolism in patients with acute exacerbations of chronic obstructive pulmonary disease: A cross-sectional study.
Autorzy:: Maritano Furcada J; Pulmonology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Castro HM; Pulmonology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
De Vito EL; Institute of Medical Research Alfredo Lanari, Universidad de Buenos Aires, Buenos Aires, Argentina.
Grande Ratti MF; Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Posadas-Martínez ML; Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Giunta DH; Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Vazquez FJ; Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Ferreyro BL; Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.; Sinai Health System/University Health Network and Interdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada.; Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada.
Źródło:: The clinical respiratory journal [Clin Respir J] 2020 Dec; Vol. 14 (12), pp. 1176-1181. Date of Electronic Publication: 2020 Oct 19.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Original Publication: Oxford : Blackwell Publishing
MeSH Terms:: Pulmonary Disease, Chronic Obstructive*/complications
Pulmonary Disease, Chronic Obstructive*/diagnosis
Pulmonary Disease, Chronic Obstructive*/epidemiology
Pulmonary Embolism*/diagnostic imaging
Pulmonary Embolism*/epidemiology
Adult ; Angiography ; Area Under Curve ; Cross-Sectional Studies ; Humans
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Contributed Indexing:: Keywords: chronic obstructive pulmonary disease; pulmonary embolism
Entry Date(s):: Date Created: 20200812 Date Completed: 20210818 Latest Revision: 20210818
Update Code:: 20240105
DOI:: 10.1111/crj.13257
PMID:: 32780471
: Czasopismo naukowe

Pełny tekst

Introduction: Pulmonary embolism (PE) remains a frequent complication in patients with chronic obstructive pulmonary disease (COPD). It is unclear that the extent to which the traditional risk stratifying scores for PE are accurate in this population.
Methods: Cross-sectional study of adult patients with COPD and suspected PE included in an Institutional Registry of Thromboembolic Disease at a tertiary teaching hospital in the city of Buenos Aires, Argentina. We estimated the area under the receiver operating characteristic curves (AU-ROC), sensitivity and specificity of the Wells and Geneva scores using a positive computed tomography angiography as the gold standard for PE. We also estimated the sensitivity and specificity for the presence of isolated worsening of dyspnea at presentation, without other cardinal symptoms of acute exacerbation of COPD.
Results: A total of 168 patients were included, of which 22% had confirmed PE. The AUC was 0.66 (95% CI 0.56-0.76) and 0.56 (95% CI 0.45-0.67) for the Wells and Geneva, respectively. Considering the most widely used cutoff points, the sensitivity and specificity were 24% and 90% for the Wells and 59% and 43% for the Geneva score, respectively. Isolated worsening of dyspnea on presentation had a sensitivity of 92% and specificity of 37%.
Conclusions: Both Wells and Geneva scores exhibit poor diagnostic accuracy for the diagnosis of PE in patients with COPD. The presence of isolated worsening of dyspnea on presentation could be an easy to identify criteria for the initial triage in this population. Further validation of our findings remains warranted.
(© 2020 John Wiley & Sons Ltd.)

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