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Survival Benefit of Obese Patients With Pulmonary Embolism

  • Karsten Keller
    Correspondence
    Correspondence: Address to Karsten Keller, MD, Center for Thrombosis and Hemostasis, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
    Affiliations
    Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
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  • Lukas Hobohm
    Affiliations
    Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany

    Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
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  • Thomas Münzel
    Affiliations
    Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany

    German Center for Cardiovascular Research, Partner Site Rhine Main, Rhine Main, Germany
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  • Mir A. Ostad
    Affiliations
    Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
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  • Christine Espinola-Klein
    Affiliations
    Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
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  • Carl J. Lavie
    Affiliations
    Department of Cardiovascular Disease, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
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  • Stavros Konstantinides
    Affiliations
    Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany

    Department of Cardiology, Democritus University Thrace, Alexandroupolis, Greece
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  • Mareike Lankeit
    Affiliations
    Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany

    Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité–University Medicine, Berlin, Germany

    Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
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      Abstract

      Objective

      To investigate the impact of obesity and underweight on adverse in-hospital outcomes in pulmonary embolism (PE).

      Patients and Methods

      Patients diagnosed as having PE based on International Statistical Classification of Diseases and Related Health Problems, 10th Revision, German Modification code I26 in the German nationwide inpatient database were stratified for obesity, underweight, and normal weight/overweight (reference group) and compared regarding adverse in-hospital outcomes.

      Results

      From January 1, 2011, through December 31, 2014, 345,831 inpatients (53.3% females) 18 years and older were included in this analysis; 8.6% were obese and 0.5% were underweight. Obese patients were younger (67.0 vs 73.0 years), were more frequently female (60.2% vs 52.7%), had a lower cancer rate (13.6% vs 20.5%), and were more often treated with systemic thrombolysis (6.4% vs 4.3%) and surgical embolectomy (0.3% vs 0.1%) vs the reference group (P<.001 for all). Overall, 51,226 patients (14.8%) died during in-hospital stay. Obese patients had lower mortality (10.9% vs 15.2%; P<.001) vs the reference group and a reduced odds ratio (OR) for in-hospital mortality (OR, 0.74; 95% CI, 0.71-0.77; P<.001) independent of age, sex, comorbidities, and reperfusion therapies. This survival benefit of obese patients was more pronounced in obesity classes I (OR, 0.56; 95% CI, 0.52-0.60; P<.001) and II (OR, 0.63; 95% CI 0.58-0.69; P<.001). Underweight patients had higher prevalence of cancer and higher mortality rates (OR, 1.15; 95% CI, 1.00-1.31; P=.04).

      Conclusion

      Obesity is associated with decreased in-hospital mortality rates in patients with PE. Although obese patients were more often treated with reperfusion therapies, the survival benefit of obese patients occurred independently of age, sex, comorbidities, and reperfusion treatment.

      Abbreviations and Acronyms:

      BMI (body mass index), COPD (chronic obstructive pulmonary disease), CPR (cardiopulmonary resuscitation), CVD (cardiovascular disease), DRG (diagnosis-related group), DVT (deep venous thrombosis or thrombophlebitis), HF (heart failure), ICD-10-GM (International Statistical Classification of Diseases and Related Health Problems, 10th Revision, German Modification), IQR (interquartile range), OPS (Operationen-und Prozedurenschlüssel), OR (odds ratio), PE (pulmonary embolism), RV (right ventricular), VTE (venous thromboembolism)
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      Linked Article

      • Obesity Paradox in Pulmonary Embolism: Myth or Reality?
        Mayo Clinic ProceedingsVol. 94Issue 10
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          Obesity, like smoking and hypertension, is a nonprovoking acquired risk factor and independent predictor of pulmonary embolism. In a population-based cohort study from the Emerging Risk Factors Collaboration in the United Kingdom,1 older age, current smoking, and higher body mass index (BMI) were consistently associated with higher venous thromboembolic (VTE) risk. Adult BMI (calculated as weight in kilograms divided by height in meters squared) is strongly associated with VTE, especially adult waist circumference, even after adjusting for adult BMI, as is increasing weight gain from young adulthood, after adjusting for current BMI, among women but not men.
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