ABSTRACT
Diagnosis of pulmonary embolism [PE] is difficult in patients complaining of acute exacerbation of chronic obstructive pulmonary disease [AECOPD]. To detect the numerical predictors in clinical, gasometric and laboratory findings for PE in patients with AECOPD. Will be used cut-off point of the different factors to reach a definite clue for this diagnostic dilemma. Ninety patients with acute exacerbation of COPD who were admitted to Chest department or Respiratory Intensive Care Unit in Assiut University Hospitals. They were 66 males and 24 females with the mean age [61.9 years]. All of them underwent the following clinical examination chest X-ray CBC, ABG, ECG; echocardiography, Duppler US of the lower limbs to diagnose DVT. Spiral CT, pulmonary angiography was performed to all patients to confirm the diagnosis of PE. Indices of coagulation, fibrinolysis and platelet activity were performed to all patients. PE was present in 25 of 90 patients [27.8%] while DVT was diagnosed in 14 cases [15.6%]. Ten patients [11.1%] have both DVT and PE. Spiral CT pulmonary angiography [SCTPA] was the diagnostic tool and the patients were divided into positive for PE 25 [27.8%] and negative [65 [72.2%]]. The Cut off points were used to give the definite diagnosis of PE among those critical patients with AECOPD as the following: Respiratory rate >35 cycles/min, heart rate > 120 beats. Hematocrite value > 56%, platelet count < 200.000/mm3, mean pulmonary artery pressure >60mmHg, P [A-a] O2 >25mmHg, D-dimer >1000ng/ml, thrombin >15mg/dL, B-Thromboglobulin > 80 IU/mL, P-selectin > 300ng/mL, duration of illness > 12 years, frequency of exacerbation > 5/year, no. of hospital admission > 4/year. This study showed a 27.8% prevelance of PE in patients with COPD hospitalized for severe exacerbation. These clinical and laboratory cut-off points can facilitate the diagnosis by a high sensitivity yield with a highly significant importance [P<0.001 - <0.02]