Review of: "Risk Factors of Pulmonary Embolism in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A retrospective clinical study"

Abstract

A retrospective clinical study.The authors performed a retrospective study of acute COPD exacerbation patients and compared risk factors associated with those with vs without concomitant pulmonary embolism. Strength:This is an important topic, and a common occurrence in the hospital.The authors looked at multiple variables. Major Issues:They state as an objective to reduce the rate of missed PE.However, a retrospective analysis that by definition has confounders does not help guide what to do next for patients prospectively.For example, how many of the patients "without PE" actually DID have PE but it just wasn't diagnosed?Separating groups simply based on final diagnoses of COPD vs COPD with PE leads to major bias -of course, the latter group will be sicker.It makes sense that multiple 'risk factors' were more prominent in the latter group compared to the former group, but this per se does not tell me what I should do next to diagnose patients.It is easy enough to say that if the dimer is elevated, the patient should be scanned.But which AECOPD patients should I order a dimer on?This is the critical question we all face when working clinically.The authors state in their conclusion that "patients hospitalized for AECOPD should have multi-slice spiral computed tomography pulmonary angiography (CTPA) to determine whether they present PE complications as soon as possible when combined with chest pain, pulmonary heart disease, prolonged immobility ≥3 days, plasma D-dimer levels higher, and the times of acute exacerbations has increased significantly in the last year."But just elevated d-dimer per se is reason enough to scan, and all the already-present algorithms already state this.Again, what's more critical is, which patients do we even workup for PE? Perhaps the focus should be on the patients that are worsening (more exacerbations or worsening mMRC), but many COPD patients worsen just from their COPD alone, so this will not be very specific.

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