Late Breaking Abstract - Frequency Pulmonary embolism (PE) in patients with an acute Exacerbation of chronic obstructive Pulmonary disease (COPD). PEP prospective trial

Abstract

Background: The frequency of PE in patients with acute exacerbation of COPD remains uncertain. Aims: To determinate PE frequency in patients with an acute COPD exacerbation, whether PE was clinically suspected or not. Method: In the “PEP” multicentre prospective cohort, patients admitted to hospital for an acute COPD exacerbation were included in 7 French Centres. A predefined and validated PE diagnosis algorithm based on GENEVA score, D-dimer, CT-scan and legs’ ultrasound was performed in all patients within 48 hours following admission with a prospective 3-month follow-up. The primary outcome was PE diagnosed at admission. Secondary outcomes were venous thromboembolism (VTE, including isolated deep vein thrombosis (DVT)) at inclusion and at 3-month follow-up in patients where PE or DVT was initially excluded and 3-month mortality. All VTE events were centrally adjudated by an independant committee. Results: At inclusion, among the 740 included patients, PE was confirmed in 44 (5.9%) and isolated DVT in 10 (1.6%), yielding a VTE prevalence of 7.3% (95%CI 5.6-9.4). In patients with (n=299) and without (n=441) clinical suspicion of PE, VTE prevalence was 11.7% (95%CI 8.6-15.9) and 4.4% (95%CI 2.8-6.6), respectively. At 3 months, among the 686 patients where PE or DVT was excluded at inclusion, PE occurred in 5 patients (2/264 patients with suspected PE and 3/422 with no PE suspicion). At 3 months, 50 patients (6.8%) died (12/44 patients with PE (27.3%) and 38/686 patients with no PE (5.5%)). Conclusion: The prevalence of PE in patients hospitalized for an acute COPD exacerbation is high and of poor prognosis, whether PE was suspected or not.