Pulmonary Vascular Disease: Pulmonary Vascular Disease: VTE |

Polycythemia Is a Risk Factor for Mortality in COPD Patients With Pulmonary Embolism FREE TO VIEW

Lu Guo, MD; Li Jiang, MD; Yun Gao, MD; Rong Ju, PhD; Jeffrey Curtis, MD; Carlos Martinez, MD
Author and Funding Information

Sichuan Academy of Medical Science, Sichuan Provincal People’s Hospital, Chengdu, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A530. doi:10.1016/j.chest.2016.02.552
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SESSION TITLE: Pulmonary Vascular Disease: VTE

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: Pulmonary embolism (PE) is frequent among subjects with chronic obstructive pulmonary disease (COPD) and associated with high mortality, but risk factors for mortality are not well known. The objective of our study was to determine if secondary polycythemia is associated with an increased mortality of acute PE in COPD patients.

METHODS: We identified all COPD patients admitted to Sichuan Provincial People's Hospital and West China Hospital of Sichuan University, Sichuan, China, who had computerized tomographic angiography (CTA) proved PE between January, 2011 and April, 2015. We extracted demographic, clinical and laboratory information at the time of admission. All subjects were followed until hospital discharge to identify in-hospital mortality. We analyzed the potential impact of polycythemia on in-hospital mortality, in multivariate models additionally adjusted for determining other risk factors for mortality and secondary polycythemia in COPD patients with PE.

RESULTS: We enrolled 105 consecutive patients with COPD and PE; 29 patients of them (27.6%) with secondary polycythemia and 76 (72.4%) with no secondary polycythemia. Compared with those without polycythemia, the polycythemic group had significantly lower PaO2 and SpO2, as well as higher PaCO2 on arterial blood gas analyses (p<0.001, p<0.001 and p=0.002, respectively). More polycythemic patients were in the stage D Group (high symptoms and high risk) of the 2011 GOLD classification (51.72% vs. 26.32% in the non-polycythemic, p=0.014). They also had higher more severe pulmonary hypertension, and with greater frequency of centrally located or bilateral pulmonary thrombi. Multivariate logistic regression analysis revealed that sPO2, PASP, main pulmonary artery embolism and polycythemia were the risk factors associated with the PE mortality in COPD patients.

CONCLUSIONS: Polycythemia is an independent risk factor for mortality in COPD patients with PE and is associated with more severe pulmonary hypertension. Identification of polycythemia will help to target a COPD subgroup at high risk for PE mortality.

CLINICAL IMPLICATIONS: PE in COPD patients with polycythemia is a fairly frequent event and may require a lower threshold for evaluating these patients for PE when they present with hypoxia and worsening pulmonary functions. PE is a treatable condition and its prompt diagnosis may decrease the morbidity and mortality in these high risk patients.

DISCLOSURE: The following authors have nothing to disclose: Lu Guo, Li Jiang, Yun Gao, Rong Ju, Jeffrey Curtis, Carlos Martinez

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