|Canadian Health Care Mall Pneumonia|
Monday, December 15, 2014
In our study, 44% of the patients had autopsy evidence of generalized atherosclerosis. PTE was another common cause of death and was frequently unrecognized. Only one-third of these patients received IV heparin. Previous studies have reported COPD as an independent risk factor for PTE as well as a high prevalence of PE in patients with unexplained exacerbations of COPD, but clear guidelines for pharmacologic PTE prophylaxis, especially in an outpatient setting, have not been defined.
Although the prevalence of PE in patients admitted to the emergency department for an acute exacerbation of COPD is found to be as low as 3%, our findings suggest that PTE has to be taken into consideration in hospitalized patients with severe exacerbation of COPD, and appropriate treatment cannot wait until the diagnosis is confirmed. In the absence of contraindications, systemic anticoagulation should be started according to clinical suspicion and continued until PTE is excluded by an appropriate diagnostic study. Pneumonia was the common cause of death in our study, despite the application of antibiotics.
The presence of multiresistant bacterial strains, progression to severe sepsis, and delayed presentation are some of the possible causes. These patients often live in bad socioeconomic conditions, with a poor quality of life, and do not present to the hospital on time. COPD patients hospitalized with community-acquired pneumonia have been previously reported to have worse clinical outcomes and higher 30- and 90-day mortality than patients without COPD. Therefore, COPD should be included in a pneumonia severity scoring system as one of the predictors of higher mortality risk.
Our study is limited by the small number of patients because the autopsy was performed only in patients who died in the first 24 h after hospital admission. The data regarding the clinical diagnosis of comorbidities and previous outpatient therapy may be incomplete, and the retrospective design of the study precluded a meaningful analysis of physicians’ intention-to-treat-associated conditions.