Inpatient Outcomes of Pulmonary Embolism in Patients with Inflammatory Bowel Disease: Insights from a Nationwide...

Background: Inflammatory bowel disease (IBD) is a chronic inflammatory disorder that confers an increased risk of venous thromboembolism (VTE) and subsequent pulmonary embolism (PE). The risk stems from chronic systemic inflammation promoting endothelial dysfunction and hypercoagulability. Data on specific inpatient outcomes and procedural needs in patients with IBD with acute PE remains limited. This study explores these outcomes at a national level. Methods: We conducted a Nationwide Inpatient Sample (NIS) database analysis (2016-2020). Adult hospitalizations for acute PE were identified using ICD-10-CM codes and stratified based on IBD status. Multivariable regression analysis was performed to determine independent associations between IBD status and in-hospital mortality, length of stay (LOS), cardiac complications, and ICU-level interventions (intubation, central venous catheterization (CVC), arterial line placement, requirement of vasopressors), and blood transfusion. Results: Among 377,143 acute PE hospitalizations, 4123 (1.1%) had IBD. Patients with IBD were younger (58.72 vs. 62.78 years, p < 0.001) and had lower prevalence of diabetes mellitus, hypertension, end-stage renal disease (ESRD), dyslipidemia, overweight/obesity, coronary artery disease and smoking status (p < 0.05). Despite a favorable baseline profile, patients with IBD had a longer length of stay (LOS) (8.82 vs. 7.30 days, p < 0.001) but no significant association with in-hospital mortality (aOR = 0.93, p = 0.281). Multivariable analysis showed patients with IBD had higher odds of requiring CVC placement (OR = 1.42, p < 0.001), vasopressors (OR = 1.22, p = 0.05), and blood transfusions (OR = 1.78, p < 0.001). Conversely, they had lower odds of cardiac arrest (OR = 0.64, p < 0.001) and cor pulmonale (OR = 0.32, p = 0.012). Conclusions: patients with IBD with acute PE represent a complex population with high resource utilization. Future research is needed the development of IBD-specific PE risk stratification, targeted management, prophylactic and therapeutic anticoagulation guidelines.