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Introduction: Chronic obstructive pulmonary disease (COPD) patients are at higher risk for pulmonary embolism (PE) due to limited mobility, smoking, inflammation or comorbidities. High D-dimer levels have been detected in many diseases including COPD exacerbation, even in the absence of detectable PE. Aims and Objectives: To determine the optimal D-dimer cutoff value for the diagnosis of PE, in patients hospitalized for COPD exacerbation. Methods: We retrospectively analyzed 180 consecutive patients, admitted to “KAA” and 5 th Respiratory Clinic of Athens Chest Hospital “Sotiria” for COPD exacerbation, according to Anthonisen criteria, during 2014. Fifty from the above patients were found to have been investigated with computed tomography angiography despite a low probability for PE (Wells score). All 50 patients had D-Dimer levels measured as well. Receiver operating characteristic (ROC) curve analysis was used to determine the accuracy of D-dimer measurements in diagnosing PE. Results: Fifty patients (72.1±12.0 years old) were included in the analysis. PE was detected in 10 patients (20%). D-dimer levels of COPD patients with PE (median value: 7655 mcg/L) were significantly higher than those of the patients without PE (median value: 940 mcg/L)(p Conclusions: Patients hospitalized for COPD exacerbation with low clinical probability for PE present D-dimer levels higher than normal, even without PE. The D-dimer cutoff value used to exclude PE should be adjusted, thus reducing the unnecessary use of diagnostic procedures.

Although much information is available for the function of circulating monocytes when signs of sepsis are apparent, little is known for natural killer (NK) cells. NK cells were isolated from 10 healthy controls and from 103 patients with sepsis within the first 24 h from diagnosis. NK cells were stimulated with lipopolysaccharide for cytokine production. Release of tumor necrosis factor-alpha and of interleukin (IL)-6 was below the limit of detection. Release of IL-23 and of interferon-gamma (IFNγ) was significantly greater among patients than among healthy volunteers. Release of IFNγ was pronounced in septic shock. Patients were divided into two subgroups based on the ratio of IFNγ to IL-23 released by the NK cells after stimulation: those with ratio ≤5 and 28-day survival 13.5%, and those with ratio >5 and 28-day survival 29.4% (p: 0.048). It is concluded that early after clinical development of sepsis, NK cells remain active for the production of IFNγ. Their activity is associated with the final outcome.