What is the clinical evidence from this study?

Study design: Observational. Population: Pulmonary embolism (n=1174196). Intervention: Diabetes mellitus vs. No diabetes mellitus. Primary outcome: In-hospital mortality (OR 1.21, 95% CI 1.20-1.23, p=<0.001).

November 15, 2021Journal of Diabetes Investigation29 citationsOpen Access

Diabetes mellitus and its impact on mortality rate and outcome in pulmonary embolism

Q: What are the key findings of this study?

Diabetes mellitus was independently associated with a significantly increased risk of in-hospital mortality (OR 1.21) in patients hospitalized with acute pulmonary embolism compared to those without diabetes.

VSVolker H. SchmittGeneral Cardiology LHLukas HobohmInterventional Cardiology VSVisvakanth SivanathanJohannes Gutenberg University Mainz

Key Result

Diabetes mellitus was independently associated with a significantly increased risk of in-hospital mortality (OR 1.21) in patients hospitalized with acute pulmonary embolism compared to those without diabetes.

Study Design

Type

Observational (n=1,174,196)

Multicenter

Yes

Structured PICO

Does diabetes mellitus increase in-hospital mortality and adverse events in patients hospitalized with pulmonary embolism?

Population

1,174,196 hospitalized patients with pulmonary embolism in Germany between 2005 and 2018, of whom 18.7% had diabetes mellitus.

Exposure

Presence of diabetes mellitus (type 1 or type 2) as a chronic disease at admission or new onset during hospitalization

Comparator

Pulmonary embolism patients without diabetes

Outcome

Death of all-causes (in-hospital death)hard clinical

Diabetes mellitus, particularly type 1, is an independent risk factor for increased in-hospital mortality and adverse events in patients with acute pulmonary embolism.

Main Result

Odds Ratio: 1.21 (95% CI 1.2–1.23)

Absolute Event Rate: 19.8% vs 14.8%

p-value: p=<0.001

Limitations

Based on ICD and OPS discharge codes, which might lead to under-reporting or under-coding.
Detailed baseline data such as concomitant medications, cardiac troponin plasma concentrations, and echocardiographic parameters were not available.
Follow-up evaluation after discharge was not possible due to the data structure including only the in-hospital stay.
Potential residual confounding despite wide adjustments in multivariate regression models.

Abstract

AIMS/INTRODUCTION: In patients with pulmonary embolism (PE), the impact of diabetes mellitus on patient profile and outcome is not well investigated. MATERIAL AND METHODS: The German nationwide inpatient sample of the years 2005-2018 was analyzed. Hospitalized PE patients were stratified for diabetes, and the impact of diabetes on in-hospital events was investigated. RESULTS: Overall, 1,174,196 PE patients (53.8% aged ≥70 years, 53.5% women) and, among these, 219,550 (18.7%) diabetes patients were included. In-hospital mortality rate amounted to 15.8%, and was higher in diabetes patients than in non-diabetes patients (19.8% vs 14.8%, P < 0.001). PE patients with diabetes had a higher prevalence of cardiovascular risk factors, comorbidities, right ventricular dysfunction (31.8% vs 27.7%, P < 0.001), prolonged in-hospital stay (11.0 vs 9.0 days, P < 0.001) and higher rates of adverse in-hospital events. Remarkably, diabetes was independently associated with increased in-hospital mortality (odds ratio OR 1.21, 95% confidence interval CI 1.20-1.23, P < 0.001) when adjusted for age, sex and comorbidities. Within the observation period of 2005-2018, a relevant decrease of in-hospital mortality in PE patients with diabetes was observed (25.5% to 16.8%). Systemic thrombolysis was more often administered to diabetes patients (OR 1.18, 95% CI 1.01-3.49, P < 0.001), and diabetes was associated with intracerebral (OR 1.19, 95% CI 1.12-1.26, P < 0.001), as well as gastrointestinal bleeding (OR 1.11, 95% CI 1.07-1.15, P < 0.001). Type 1 diabetes mellitus was shown to be a strong risk factor in PE patients for shock, right ventricular dysfunction, cardiopulmonary resuscitation and in-hospital death (OR 1.75, 95% CI 1.61-1.90, P < 0.001). CONCLUSIONS: Despite the progress in diabetes treatments, diabetes is still associated with an unfavorable clinical patient profile and higher risk for adverse events, including substantially increased in-hospital mortality in acute PE.

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