{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T08:28:39Z","timestamp":1787128119110,"version":"build-2736575974"},"reference-count":26,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Pulmonary thromboembolism (PTE) may mimic or aggravate acute exacerbations of chronic obstructive pulmonary disease (AECOPD). We evaluated the frequency of diagnosed PTE, associated factors, and D-dimer performance in hospitalized patients with AECOPD. Methods: In this single-center retrospective study, 429 consecutive patients hospitalized after presenting at the emergency department with AECOPD between 1 June 2022 and 1 June 2023 were screened; 330 met the eligibility criteria. D-dimer testing was performed at the physician\u2019s discretion in 181 patients, who constituted the primary analysis population, and 87 underwent confirmatory imaging. PTE was confirmed by computed tomography pulmonary angiography or ventilation\/perfusion scintigraphy. Results: PTE was diagnosed in 38 patients, corresponding to 21.0% of the D-dimer-tested population and an observed frequency of 11.5% in the overall eligible cohort. In the primary analysis population, D-dimer showed good discrimination for diagnosed PTE (AUC, 0.826; 95% CI, 0.754\u20130.898; p &lt; 0.001). The exploratory 1053 ng\/mL FEU threshold yielded 84.2% sensitivity and 73.4% specificity. In the imaging-confirmed subgroup, the AUC was 0.733 (95% CI, 0.627\u20130.838), and specificity at this threshold was 55.1%. D-dimer &gt; 1053 ng\/mL FEU (adjusted OR, 20.32; 95% CI, 6.80\u201360.66), female sex (adjusted OR, 4.40; 95% CI, 1.55\u201312.51), and lower C-reactive protein levels (adjusted OR per 10 mg\/L increase, 0.90; 95% CI, 0.83\u20130.98) were independently associated with diagnosed PTE. Conclusions: Diagnosed PTE was frequent among D-dimer-tested hospitalized patients with AECOPD. Because testing and imaging were physician-directed rather than protocolized, the true prevalence in the overall cohort could not be determined. The 1053 ng\/mL FEU threshold should be considered exploratory and requires external validation.<\/jats:p>","DOI":"10.3390\/jcm15166394","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T07:58:23Z","timestamp":1787126303000},"page":"6394","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pulmonary Thromboembolism in Hospitalized Patients with Acute Exacerbation of COPD: Frequency, Predictors, and D-Dimer Performance"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6421-2577","authenticated-orcid":false,"given":"Selma Nur","family":"\u00d6zkiraz Binici","sequence":"first","affiliation":[{"name":"Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, University of Health Sciences, 35110 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6657-0125","authenticated-orcid":false,"given":"Onur","family":"Binici","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, University of Health Sciences, 35110 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sami","family":"Deniz","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, University of Health Sciences, 35110 Izmir, Turkey"},{"name":"The Department of Chest Diseases, Izmir Faculty of Medicine, University of Health Sciences Turkey, 35100 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1164\/ajrccm.157.5.9709032","article-title":"Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease","volume":"157","author":"Seemungal","year":"1998","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"46s","DOI":"10.1183\/09031936.03.00078002","article-title":"COPD exacerbations: Definitions and classifications","volume":"21","author":"Burge","year":"2003","journal-title":"Eur. Respir. J."},{"key":"ref_3","unstructured":"Global Initiative for Chronic Obstructive Lung Disease (2025, November 23). 2026 GOLD Report and Pocket Guide. Available online: https:\/\/goldcopd.org\/2026-gold-report-and-pocket-guide\/."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"653","DOI":"10.2147\/COPD.S34186","article-title":"Exacerbation frequency and course of COPD","volume":"7","author":"Halpin","year":"2012","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1016\/j.chest.2024.07.150","article-title":"Exacerbation history and risk of myocardial infarction and pulmonary embolism in COPD","volume":"166","author":"Stridsman","year":"2024","journal-title":"Chest"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1590\/S1806-37132014000100006","article-title":"Incidence of pulmonary embolism during COPD exacerbation","volume":"40","author":"Akpinar","year":"2014","journal-title":"J. Bras. Pneumol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/S2213-2600(17)30207-2","article-title":"Frequency of exacerbations in patients with chronic obstructive pulmonary disease: An analysis of the SPIROMICS cohort","volume":"5","author":"Han","year":"2017","journal-title":"Lancet Respir. Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Li, M., Jiang, Y., Xu, Y., and Li, Q. (2025). The prevalence and risk factors of pulmonary embolism in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Thromb. J., 23.","DOI":"10.1186\/s12959-025-00728-6"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"25","DOI":"10.4103\/abr.abr_219_24","article-title":"Frequency of pulmonary embolism in patients with COPD exacerbation and clinical and laboratory predictive factors","volume":"15","author":"Keymanesh","year":"2026","journal-title":"Adv. Biomed. Res."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Fu, X., Zhong, Y., Xu, W., Ju, J., Yu, M., Ge, M., Gu, X., Chen, Q., Sun, Y., and Huang, H. (2021). The prevalence and clinical features of pulmonary embolism in patients with AE-COPD: A meta-analysis and systematic review. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0256480"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1001\/jama.2020.23567","article-title":"Prevalence of pulmonary embolism among patients with COPD hospitalized with acutely worsening respiratory symptoms","volume":"325","author":"Couturaud","year":"2021","journal-title":"JAMA"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1001\/jama.2021.14846","article-title":"Effect of a pulmonary embolism diagnostic strategy on clinical outcomes in patients hospitalized for COPD exacerbation: A randomized clinical trial","volume":"326","author":"Tabernero","year":"2021","journal-title":"JAMA"},{"key":"ref_13","first-page":"371","article-title":"Diagnostic value of D-dimer in detecting pulmonary embolism in patients with acute COPD exacerbation","volume":"19","author":"Sadeghi","year":"2020","journal-title":"Tanaffos"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Cioboata, R., Olteanu, M., Mitroi, D.M., Ro\u0219u, S.M., Tieranu, M.L., Vlasceanu, S.G., Neamtu, S.D., Tieranu, E.N., Padureanu, R., and Balteanu, M.A. (2026). Beyond the lungs: Cardiovascular risk in COPD patients with a history of tuberculosis\u2014A narrative review. J. Clin. Med., 15.","DOI":"10.3390\/jcm15020661"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/15412555.2022.2139671","article-title":"Optimizing the diagnostic algorithm for pulmonary embolism in acute COPD exacerbation using fuzzy rough sets and support vector machine","volume":"20","author":"Yu","year":"2023","journal-title":"J. Chronic Obstr. Pulm. Dis."},{"key":"ref_16","first-page":"430","article-title":"Should the cut-off value of D-dimer be elevated to exclude pulmonary embolism in acute exacerbation of COPD?","volume":"5","author":"Akpinar","year":"2013","journal-title":"J. Thorac. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Han, W., Wang, M., Xie, Y., Ruan, H., Zhao, H., and Li, J. (2022). Prevalence of pulmonary embolism and deep venous thromboembolism in patients with acute exacerbation of chronic obstructive pulmonary disease: A systematic review and meta-analysis. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.732855"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1016\/S0140-6736(22)01273-9","article-title":"Towards the elimination of chronic obstructive pulmonary disease: A Lancet Commission","volume":"400","author":"Stolz","year":"2022","journal-title":"Lancet"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1378\/chest.08-1516","article-title":"Prevalence of pulmonary embolism in acute exacerbations of COPD","volume":"135","author":"Rizkallah","year":"2009","journal-title":"Chest"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1080\/17474086.2017.1353416","article-title":"The potential role of endothelial dysfunction and platelet activation in the development of thrombotic risk in COPD patients","volume":"10","author":"Malerba","year":"2017","journal-title":"Expert Rev. Hematol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1080\/15412555.2021.1900094","article-title":"Endothelial dysfunction during acute exacerbations of chronic obstructive pulmonary disease: A systematic review and meta-analysis","volume":"18","author":"Theodorakopoulou","year":"2021","journal-title":"J. Chronic Obstr. Pulm. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Liu, M., Hu, R., Jiang, X., and Mei, X. (2021). Coagulation dysfunction in patients with AECOPD and its relation to infection and hypercapnia. J. Clin. Lab. Anal., 35.","DOI":"10.1002\/jcla.23733"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.thromres.2023.09.013","article-title":"Pulmonary embolism diagnostic strategies in patients with COPD exacerbation: Post-hoc analysis of the PEP trial","volume":"231","author":"Rambaud","year":"2023","journal-title":"Thromb. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"4461","DOI":"10.1113\/JP286655","article-title":"Chemoreflex function in pulmonary diseases\u2014A review","volume":"603","author":"Kamra","year":"2025","journal-title":"J. Physiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"00202","DOI":"10.1183\/23120541.00202-2025","article-title":"COPD exacerbation purulence status and its association with pulmonary embolism: A systematic review with meta-analysis","volume":"11","author":"Mai","year":"2025","journal-title":"ERJ Open Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1093\/eurheartj\/ehz405","article-title":"2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)","volume":"41","author":"Konstantinides","year":"2020","journal-title":"Eur. Heart J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6394\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T08:19:03Z","timestamp":1787127543000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6394"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,19]]},"references-count":26,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15166394"],"URL":"https:\/\/doi.org\/10.3390\/jcm15166394","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,19]]}}}