Clinical and Socioeconomic Predictors of In-hospital Mortality in Acute Pulmonary Embolism: A Cross-sectional Study using the US National Inpatient Sample data

Background: In-hospital mortality from acute pulmonary embolism (PE) remains substantial despite advances in diagnosis and management. Objectives: We sought to evaluate clinical and socioeconomic predictors of in-hospital mortality among adults hospitalized with acute PE in a nationally representative US cohort. Methods: We conducted a cross-sectional study using the US National Inpatient Sample from 2018 to 2021. Adults hospitalized with a primary diagnosis of acute PE were identified using International Classification of Diseases, Tenth Revision, codes. Multivariable logistic regression was used to evaluate patient- and hospital-level predictors of in-hospital mortality. Comorbidity burden was assessed using the continuous Elixhauser comorbidity index. Analyses were performed using STATA 17.0. Results: An estimated 723,579 (weighted) hospitalizations for acute PE were identified, with in-hospital mortality rate of 3%. Mean age was 63 (SD, 16) years. In adjusted analyses, markers of acute physiologic compromise demonstrated the strongest associations with mortality; lactic acidosis was associated with a 7-fold increase in the odds ratio of death (aOR, 7.04; 95% CI, 6.56-7.54). Increasing comorbidity burden was independently associated with mortality, with each 1-point increase in Elixhauser comorbidity index corresponding to a 20% increase in mortality odds ratio. Metastatic cancer, liver disease, arrhythmias, and coagulopathy were also significant predictors. Female sex and selected racial groups-including Black and Asian/Pacific Islander patients-had higher adjusted odds ratio of mortality than White patients. Self-pay status was associated with higher mortality than Medicare, while increasing household income quartiles were associated with progressively lower mortality. Obesity and chronic hypertension were associated with lower adjusted mortality. Conclusion: In this national cohort, in-hospital mortality following acute PE was most strongly associated with acute physiologic derangement and cumulative comorbidity burden. Socioeconomic characteristics were independently associated with mortality, reflecting the multifactorial nature of inpatient outcomes. These findings support a multidimensional approach to risk assessment while highlighting the need for further investigation into mechanisms underlying observed associations.