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      The prevalence and clinical features of pulmonary embolism in patients with AE-COPD: A meta-analysis and systematic review

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          Abstract

          Background

          The prevalence of pulmonary embolism (PE) in the acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) is highly controversial. We conducted a systematic review and meta-analysis to summarize the epidemiology and characteristics of PE with AE-COPD for current studies.

          Methods

          We searched the PubMed, EMBASE, Cochrane Library and Web of Science databases for studies published prior to October 21, 2020. Pooled proportions with 95% confidence intervals (95% CIs) were calculated using a random effects model. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals were used as effect measures for dichotomous and continuous variables, respectively.

          Results

          A total of 17 studies involving 3170 patients were included. The prevalence of PE and deep vein thrombosis (DVT) in AE-COPD patients was 17.2% (95% CI: 13.4%-21.3%) and 7.1% (95% CI: 3.7%-11.4%%), respectively. Dyspnea (OR = 6.77, 95% CI: 1.97–23.22), pleuritic chest pain (OR = 3.25, 95% CI: 2.06–5.12), lower limb asymmetry or edema (OR = 2.46, 95% CI:1.51–4.00), higher heart rates (MD = 20.51, 95% CI: 4.95–36.08), longer hospital stays (MD = 3.66, 95% CI: 3.01–4.31) were associated with the PE in the AE-COPD patients. Levels of D-dimer (MD = 1.51, 95% CI: 0.80–2.23), WBC counts (MD = 1.42, 95% CI: 0.14–2.70) were significantly higher and levels of PaO 2 was lower (MD = -17.20, 95% CI: -33.94- -0.45, P<0.05) in the AE-COPD with PE group. The AE-COPD with PE group had increased risk of fatal outcome than the AE-COPD group (OR = 2.23, 95% CI: 1.43–3.50).

          Conclusions

          The prevalence of PE during AE-COPD varies considerably among the studies. AE-COPD patients with PE experienced an increased risk of death, especially among the ICU patients. Understanding the potential risk factors for PE may help clinicians identify AE-COPD patients at increased risk of PE.

          Prospero registration number

          CRD42021226568.

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          Most cited references59

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          Measuring inconsistency in meta-analyses.

          Julian P. T. Higgins, Simon Thompson, Jonathan Deeks … (2003)
          Article 0 comments Cited 10130 times – based on 0 reviews     Review now
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            Quantifying heterogeneity in a meta-analysis.

            Julian P T Higgins, Simon G Thompson (2002)
            The extent of heterogeneity in a meta-analysis partly determines the difficulty in drawing overall conclusions. This extent may be measured by estimating a between-study variance, but interpretation is then specific to a particular treatment effect metric. A test for the existence of heterogeneity exists, but depends on the number of studies in the meta-analysis. We develop measures of the impact of heterogeneity on a meta-analysis, from mathematical criteria, that are independent of the number of studies and the treatment effect metric. We derive and propose three suitable statistics: H is the square root of the chi2 heterogeneity statistic divided by its degrees of freedom; R is the ratio of the standard error of the underlying mean from a random effects meta-analysis to the standard error of a fixed effect meta-analytic estimate, and I2 is a transformation of (H) that describes the proportion of total variation in study estimates that is due to heterogeneity. We discuss interpretation, interval estimates and other properties of these measures and examine them in five example data sets showing different amounts of heterogeneity. We conclude that H and I2, which can usually be calculated for published meta-analyses, are particularly useful summaries of the impact of heterogeneity. One or both should be presented in published meta-analyses in preference to the test for heterogeneity. Copyright 2002 John Wiley & Sons, Ltd.
            Article 0 comments Cited 5811 times – based on 0 reviews     Review now
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              Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

              David Moher, Alessandro Liberati, Jennifer Tetzlaff … (2010)
              Article 0 comments Cited 2025 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Xiaofang Fu: Role: Data curationRole: Formal analysisRole: Writing – original draft
                Yonghong Zhong: Role: Data curationRole: Writing – original draft
                Wucheng Xu: Role: Data curation
                Jiangang Ju: Role: Data curation
                Min Yu: Role: Data curation
                Minjie Ge: Role: Data curation
                Xiaofei Gu: Role: Data curation
                Qingqing Chen: Role: Data curation
                Yibo Sun: Role: Data curation
                Huaqiong Huang: Role: SupervisionRole: Writing – review & editing
                Linfeng Shen:
                ORCID: https://orcid.org/0000-0002-1350-6583
                Role: Data curationRole: SupervisionRole: Writing – review & editing
                Amit Bahl: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS One
                Journal ID (publisher-id): plos
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 2 September 2021
                Publication date Collection: 2021
                Volume: 16
                Issue: 9
                Electronic Location Identifier: e0256480
                Affiliations
                [1 ] Department of Respiratory, First People’s Hospital of Yuhang, Hangzhou, China
                [2 ] Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
                Beaumont Hospitals: Beaumont Health, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-1350-6583
                Article
                Publisher ID: PONE-D-21-09812
                DOI: 10.1371/journal.pone.0256480
                PMC ID: 8412363
                PubMed ID: 34473738
                SO-VID: fa78ad43-93c7-4bc7-8433-0f2b23766404
                Copyright © © 2021 Fu et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 4 April 2021
                Date accepted : 8 August 2021
                Page count
                Figures: 5, Tables: 0, Pages: 14
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Pulmonology
                Subject: Chronic Obstructive Pulmonary Disease
                Subject: Research and Analysis Methods
                Subject: Mathematical and Statistical Techniques
                Subject: Statistical Methods
                Subject: Metaanalysis
                Subject: Physical Sciences
                Subject: Mathematics
                Subject: Statistics
                Subject: Statistical Methods
                Subject: Metaanalysis
                Subject: Research and Analysis Methods
                Subject: Research Assessment
                Subject: Systematic Reviews
                Subject: Medicine and Health Sciences
                Subject: Medical Conditions
                Subject: Respiratory Disorders
                Subject: Dyspnea
                Subject: Medicine and Health Sciences
                Subject: Pulmonology
                Subject: Respiratory Disorders
                Subject: Dyspnea
                Subject: Medicine and Health Sciences
                Subject: Epidemiology
                Subject: Medical Risk Factors
                Subject: Biology and Life Sciences
                Subject: Population Biology
                Subject: Population Metrics
                Subject: Death Rates
                Subject: Science Policy
                Subject: Research Integrity
                Subject: Publication Ethics
                Subject: Research and Analysis Methods
                Subject: Database and Informatics Methods
                Subject: Database Searching
                Custom metadata
                Data Availability All relevant data are within the manuscript and its S1 Checklist, S1 and S2 Figs, S1– S4 Tables files.

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