What is the clinical evidence from this study?

Study design: Observational. Population: High-risk pulmonary embolism (n=29610). Intervention: Obesity (BMI 30 to <40 kg/m2) vs. Non-obese (BMI <30 kg/m2). Primary outcome: All-cause in-hospital mortality (aOR 0.50, 95% CI 0.45-0.54, p=<0.001).

What does this research mean for the field?

Obesity is associated with significantly lower in-hospital mortality and fewer major adverse cardiovascular and cerebrovascular events compared to non-obese patients with high-risk pulmonary embolism, demonstrating an obesity paradox. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

April 18, 2025Open Access

Impact of obesity on clinical outcomes in patients with high-risk pulmonary embolism: A comparative analysis

Q: What are the key findings of this study?

Obesity was associated with significantly lower in-hospital mortality (aOR 0.50) compared to non-obese patients with high-risk pulmonary embolism, demonstrating an obesity paradox.

Q: What does this research mean for the field?

Obesity is associated with significantly lower in-hospital mortality and fewer major adverse cardiovascular and cerebrovascular events compared to non-obese patients with high-risk pulmonary embolism, demonstrating an obesity paradox. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

ZSZiv ShacharTechnion – Israel Institute of Technology MGMarlon V. GatuzHillel Yaffe Medical Center AFAdam FolmanHillel Yaffe Medical Center

Key Result

Obesity was associated with significantly lower in-hospital mortality (aOR 0.50) compared to non-obese patients with high-risk pulmonary embolism, demonstrating an obesity paradox.

Study Design

Type

Observational (n=29,610)

Multicenter

Yes

Structured PICO

Does obesity improve in-hospital clinical outcomes in adult patients with high-risk pulmonary embolism?

Population

29,610 adult patients hospitalized with high-risk acute pulmonary embolism (defined as PE with cardiogenic shock, mechanical ventilation, mechanical circulatory support, or vasopressors) from the US National Inpatient Sample (2016-2019). Excluded: patients with malignancy.

Intervention

Obesity (BMI 30 to < 40 kg/m2) and severe obesity (BMI ≥40 kg/m2)

Comparator

Non-obese (BMI < 30 kg/m2)

Outcome

All-cause in-hospital mortalityhard clinical

In patients with high-risk pulmonary embolism, obesity and severe obesity are paradoxically associated with lower in-hospital mortality and fewer major adverse cardiovascular events compared to non-obese patients.

Main Result

Effect estimate: aOR 0.50 (95% CI 0.45-0.54)

Absolute Event Rate: 27.2% vs 43.1%

p-value: p=<0.001

Limitations

Retrospective design with potential administrative data inaccuracies
Lack of long-term follow-up and absence of chronic treatment/medication data
Inability to differentiate body composition profiles (cannot distinguish between protective adiposity and sarcopenic obesity)
Possible selection bias toward less severe PE phenotypes in obese patients

Abstract

Background: Pulmonary embolism (PE) is a life-threatening cardiovascular condition with increasing global incidence. Obesity is a significant risk factor for PE, although its reported relationship with outcomes is inconsistent. This study aimed to investigate the impact of obesity on clinical outcomes in patients with high-risk PE. Methods: ). We compared baseline characteristics, in-hospital procedures, and outcomes among these groups. Multivariable logistic regression models assessed the relationship between obesity levels and in-hospital outcomes. Results: Of 752,660 patients with PE, 29,610 (3.9 %) were classified as high-risk. The distribution among BMI categories was: non-obese (77.1 %), obese (8.8 %), and severely obese (14.1 %). Severely obese patients were younger (mean age 55.7 vs. 66.1 years for non-obese, p < 0.001) and more likely to be female (63.2 % vs. 51.4 % for non-obese, p < 0.001). After adjustment, obese and severely obese patients had lower odds of in-hospital mortality (obese: aOR 0.50, p < 0.001; severely obese: aOR 0.69, p < 0.001) and major adverse cardiovascular and cerebrovascular events (obese: aOR 0.50, p < 0.001; severely obese: aOR 0.72, p < 0.001). Conclusion: Our study revealed an "obesity paradox" in high-risk PE patients, with obese and severely obese individuals showing lower mortality and fewer complications despite higher comorbidity rates. These findings emphasize the need for tailored risk assessment and treatment strategies in obese patients with high-risk PE.

Ask AI

Helpful

Bookmark

View Full Paper