Impact of Pulmonary Embolism Diagnostic Strategies on Clinical Outcomes of Hospitalized Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

XING Ningning; LIU Honghong; LU Lingqun; LIU Xiaobin; WANG Jinguo

doi:10.3639/i.issn.2095-3097.2024.10.016

Abstract：Objective To investigate the impact of pulmonary embolism(PE)diagnostic strategy on clinical outcomes of hospitalized patients with chronic obstructive pulmonary disease(COPD)exacerbation.Methods A total of 126 elderly patients with acute exacerbation of COPD in Xingtai Central Hospital,Hebei Province from January 2021 to January 2024 were selected and divided into the intervention group(n=60)and the control group(n=66)according to whether the patients received PE screening.All patients received standard clinical management for COPD exacerbation.The intervention results were recorded,and the clinical outcomes within 90 days of enrollment were observed to analyze the differences of different diagnosis and treatment strategies.Results All patients in the intervention group received D-dimer(D-D)test within 12 hours after grouping,with a mean value of(560±216)ng/mL.There were 30 D-D negative patients,among which 3 cases(10.00％)underwent CT pulmonary angiography(CTPA)examination,and 1 case was diagnosed with segmental PE(1.67％);among 30 D-D positive patients,28 cases(93.33％)underwent CTPA examination,and 3 cases(10.00％)had PE.Among 31 patients who underwent CTPA(3 D-D negative and 28 D-D positive),the prevalence of PE was 12.9％.The incidence of composite outcome in the intervention group was 20.00％(12/60),and that in the control group was 40.91％(27/66).The intervention group was significantly lower than the control group(P=0.011).The readmission rate due to COPD exacerbation in the intervention group was 15.00％(9/60),and that in the control group was 28.79％(19/66).The intervention group was significantly lower than the control group(P=0.018).There was no significant difference in the incidence of other clinical outcomes between the two groups(all P＞0.05).During the follow-up period(90 days),12 cases in the intervention group and 27 cases in the control group experienced composite outcome,with a relative risk(RR)of 0.600[95％CI:0.326-1.105].Nine cases in the intervention group and 19 cases in the control group experienced readmission due to COPD exacerbation,with an RR of 0.521[95％CI:0.256-1.062].Conclusion In patients hospitalized due to COPD exacerbation,compared with simple conventional treatment,the intervention of pulmonary embolism diagnostic strategy can correct the patients'recent adverse clinical outcomes,and this intervention strategy can be added based on the patients'wishes and clinical manifestations.