Body Mass Index and In-Hospital Management and Outcomes of Pulmonary Embolism: A Nationwide Analysis

Limited data exist on the impact of body mass index (BMI) on the outcomes of admissions with acute pulmonary embolism (PE).

All adult (≥18 years) admissions with a primary diagnosis of PE were identified using the National Inpatient Sample (2016-2020) and categorized using BMI into underweight (<19.9 kg/m 2 ), normal (19.9-24.9 kg/m 2 ), and overweight/obese (>24.9 kg/m 2 ). Outcomes included in-hospital mortality, utilization of PE therapies, and resource utilization.

Of 904,260 admissions, 1.8%, 70.4%, and 27.7% were underweight, normal, and overweight/obese, respectively. Underweight admissions were on average older (70.8 ± 0.2, 64.6 ± 0.05, 58.2 ± 0.07 years), male (56.7%, 49%, 58.3%) with higher comorbidity (Elixhauser Index 5.8 ± 0.03, 4 ± 0.06, 5.1 ± 0.09), from a lower socioeconomic status, and with Medicare insurance compared to normal and overweight/obese categories ( P < 0.001). The underweight cohort had higher rates of acute organ failure, bleeding complications, strokes, shock, and higher mechanical ventilation and hemodialysis use. In contrast to the underweight group, normal and overweight/obese groups had higher rates of mechanical thrombectomy (0.3%, 1.1%, 1.9%), systemic thrombolysis (1.5%, 2.6%, 4.2%), catheter directed therapy (0.9%, 3%, 5.8%), and surgical thrombectomy (0.0%, 0.1%, 0.2%) ( P < 0.001). Compared to the normal cohort (3.3%), the underweight cohort had higher [7.8%; odds ratio 1.85 (95% confidence interval 1.54-2.21)], whereas the overweight/obese cohort had lower [2.2%; odds ratio 0.47 (95% confidence interval 0.42-0.52)] in-hospital mortality (both P < 0.001). The underweight cohort had longer hospitalization stays, higher hospitalization costs, and were discharged home less frequently.

Compared to those with normal BMI, underweight status was associated with worse outcomes in those hospitalization with acute PE.