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Prognostic characteristics and body mass index in patients with pulmonary embolism: does size matter?

Ludo F.M. Beenen, Luuk J.J. Scheres, Jaap Stoker, Saskia Middeldorp
ERJ Open Research 2020 6: 00163-2019; DOI: 10.1183/23120541.00163-2019
Ludo F.M. Beenen
1Dept of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Luuk J.J. Scheres
2Dept of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Jaap Stoker
1Dept of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Saskia Middeldorp
2Dept of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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  • FIGURE 1
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    FIGURE 1

    Association between body mass index (BMI) categories and clinical and radiological parameters with BMI 18.5–24.9 kg·m−2 as a reference. Odds ratios for a) N-terminal pro-brain natriuretic peptide, b) high-risk simplified pulmonary embolism severity index score, c) pulmonary trunk >29 mm, d) right/left ventricular diameter ratio >1.0, e) central embolism and d) concurrent deep venous thrombosis are shown. Error bars present 95% confidence intervals.

  • FIGURE 2
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    FIGURE 2

    Association between body mass index (BMI) categories and outcomes with BMI 18.5–24.9 kg·m−2 as reference. Odds ratios for a) death, b) recurrent venous thromboembolism, c) hospitalisation, d) bleeding and e) all adverse events are shown. Error bars represent 95% confidence intervals.

Tables

  • Figures
  • TABLE 1

    Baseline characteristics

    TotalBMI <18.5 kg·m−2BMI 18.5–24.99 kg·m−2BMI >25 kg·m−2
    Included1911 (100%)29 (1.5%)493 (25.8%)1389 (72.7%)
    Clinical
     Age years56.9±16.656.6±23.955.7±18.857.3±15.5
     Weight kg84.6±20.149.9±8.066.7±10.091.7±18.2
     SBP mmHg128±16.5118±15.4126±16.8129±16.3
     DBP mmHg76±11.069±8.874±10.677±11.1
     Heart rate beats per min80±14.285±10.080±14.780±14.1
     Age <50 years629 (32.9%)11 (37.9%)190 (38.5%)428 (30.8%)
     Age >65 years696 (36.4%)14 (48.3%)183 (37.1%)499 (35.9%)
     Weight <60 kg187 (9.8%)24 (82.8%)144 (29.2%)19 (1.4%)
     Current alcohol use741 (38.8%)10 (34.5%)199 (40.4%)532 (38.3%)
     Smoking834 (43.6%)15 (51.7%)235 (47.7%)584 (42.0%)
     NT-proBNP >600 pg·mL−1504 (27.3%)12 (42.9%)115 (23.9%)377 (28.2%)
     sPESI# high risk ≥11028 (53.8%)21 (72.4%)251 (50.9%)756 (54.4%)
     Unprovoked PE1266 (66.2%)21 (72.4%)327 (66.3%)918 (66.1%)
     Concurrent DVT447 (23.4%)3 (10.3%)102 (20.7%)342 (24.6%)
    Risk factors
     Recent surgery, trauma or immobilisation364 (19.0%)5 (17.2%)76 (15.4%)283 (20.4%)
     Sitting >4 h182 (9.5%)1 (3.4%)58 (11.8%)123 (8.9%)
     Oestrogen drug use193 (10.1%)8 (27.6%)73 (14.8%)112 (8.1%)
     Previous DVT/PE405 (21.2%)1 (3.4%)85 (17.2%)319 (23.0%)
     Thrombophilia94 (4.9%)1 (3.4%)32 (6.5%)61 (4.4%)
    Concomitant disease history
     Hypertension793 (41.5%)11 (37.9%)136 (27.6%)646 (46.5%)
     Diabetes194 (10.2%)3 (10.3%)18 (3.7%)173 (12.5%)
     Cardiovascular disease306 (16.0%)6 (20.7%)82 (16.6%)218 (15.7%)
     Chronic heart failure34 (1.8%)2 (6.9%)6 (1.2%)26 (1.8%)
     Cerebrovascular disease71 (3.7%)1 (3.4%)20 (4.1%)50 (3.6%)
     Stroke34 (1.8%)1 (3.4%)11 (2.2%)22 (1.6%)
     Renal disease128 (6.7%)2 (6.9%)30 (6.1%)96 (6.9%)
     Hepatic disease207 (10.8%)3 (10.3%)47 (9.5%)157 (10.8%)
     Pulmonary disease391 (20.5%)12 (41.4%)91 (18.5%)288 (20.7%)
     COPD100 (5.2%)7 (24.1%)35 (7.1%)58 (4.2%)
     Pulmonary hypertension43 (2.3%)2 (6.9%)6 (1.2%)35 (2.5%)
     Cancer221 (11.6%)6 (20.7%)65 (13.2%)150 (10.8%)

    Data are presented as mean±sd unless otherwise stated. SBP: systolic blood pressure; DBP: diastolic blood pressure; NT-proBNP: N-terminal pro-brain natriuretic peptide; sPESI: simplified Pulmonary Embolism Severity Index; PE: pulmonary embolus; DVT: deep vein thrombosis. #: item on oxygen considered positive if patient needed oxygen administration.

    • TABLE 2

      Distribution of patients according to World Health Organization body mass index (BMI) categories (N=1911)

      BMI <18.5 kg·m−229 (1.5%)
      BMI 18.5–24.9 kg·m−2493 (25.8%)
      BMI 25–29.9 kg·m−2717 (37.5%)
      BMI 30–34.9 kg·m−2414 (21.7%)
      BMI 35–39.9 kg·m−2154 (8.1%)
      BMI ≥40 kg·m−2104 (5.4%)
      Complete1950#

      #: body height was not available in 39 (2.0%) out of 1950 patients so in these patients, BMI could not be calculated.

      • TABLE 3

        Odds ratios for clinical and radiological parameters and outcomes according to World Health Organization body mass index (BMI) categories

        PatientsUnadjusted OR (95% CI)Adjusted# OR (95% CI)
        Clinical and radiological parameters
         NT-proBNP >600 pg·mL−1
          BMI <18.5 kg·m−212 (42.8%)2.38 (1.09–5.18)2.62 (1.10–6.23)
          BMI 18.5–24.9 kg·m−2115 (24.0%)1 (ref.)1 (ref.)
          BMI 25.0–29.9 kg·m−2162 (23.4%)0.97 (0.74–1.28)0.98 (0.74–1.31)
          BMI 30.0–34.9 kg·m−2124 (31.2%)1.44 (1.07–1.94)1.41 (1.03–1.93)
          BMI 35.0–39.9 kg·m−250 (34.0%)1.64 (1.10–2.44)1.62 (91.06–2.48)
          BMI >40 kg·m−241 (41.0%)2.21 (1.41–3.46)2.90 (1.79–4.70)
         sPESI high risk
          BMI <18.5 kg·m−221 (72.4%)2.52 (1.10–5.80)2.49 (1.08–5.75)
          BMI 18.5–24.9 kg·m−2251 (51.0%)1 (ref.)1 (ref.)
          BMI 25.0–29.9 kg·m−2375 (52.4%)1.06 (0.84–1.33)1.11 (0.88–1.40)
          BMI 30.0–34.9 kg·m−2230 (55.7%)1.21 (0.93–1.57)1.23 (0.95–1.60)
          BMI 35.0–39.9 kg·m−284 (54.5%)1.15 (0.80–1.66)1.13 (0.78–1.62)
          BMI >40 kg·m−266 (63.5%)1.67 (1.08–2.58)1.55 (1.00–2.41)
         Pulmonary trunk >29 mm
          BMI <18.5 kg·m−28 (27.6%)1.39 (0.60–3.22)1.36 (0.56–3.28)
          BMI 18.5–24.9 kg·m−2106 (21.5%)1 (ref.)1 (ref.)
          BMI 25.0–29.9 kg·m−2232 (32.4%)1.75 (1.34–2.28)1.66 (1.27–2.19)
          BMI 30.0–34.9 kg·m−2168 (40.7%)2.50 (1.87–3.34)2.44 (1.81–3.28)
          BMI 35.0–39.9 kg·m−259 (38.3%)2.26 (1.53–3.34)2.37 (1.59–3.53)
          BMI >40 kg·m−249 (47.1%)3.24 (2.09–5.04)4.32 (2.73–6.83)
         RV/LV >1.0
          BMI <18.5 kg·m−24 (13.8%)0.45 (0.15–1.31)0.40 (0.13–1.12)
          BMI 18.5–24.9 kg·m−2130 (26.4%)1 (ref.)1 (ref.)
          BMI 25.0–29.9 kg·m−2231 (32.3%)1.33 (1.03–1.71)1.31 (1.01–1.70)
          BMI 30.0–34.9 kg·m−2157 (38.0%)1.71 (1.29–2.27)1.66 (1.24–2.21)
          BMI 35.0–39.9 kg·m−248 (31.2%)1.26 (0.85–1.88)1.24 (0.83–1.85)
          BMI >40 kg·m−241 (39.4%)1.81 (1.17–2.81)2.12 (1.34–3.33)
         Central embolus
          BMI <18.5 kg·m−27 (24.1%)0.78 (0.33–1.86)0.75 (0.31–1.82)
          BMI 18.5–24.9 kg·m−2143 (29.1%)1 (ref.)1 (ref.)
          BMI 25.0–29.9 kg·m−2234 (32.7%)1.19 (1.19–0.92)1.17 (0.91–1.50)
          BMI 30.0–34.9 kg·m−2167 (40.4%)1.66 (1.26–2.19)1.61 (1.22–2.13)
          BMI 35.0–39.9 kg·m−262 (40.3%)1.65 (1.30–2.40)1.61 (1.10–2.36)
          BMI >40 kg·m−249 (47.1%)2.17 (1.41–3.35)2.34 (1.51–3.62)
         Concurrent DVT
          BMI <18.5 kg·m−23 (10.3%)0.44 (0.13–1.49)0.45 (0.13–1.52)
          BMI 18.5–24.9 kg·m−2102 (20.7%)1 (ref.)1 (ref.)
          BMI 25.0–29.9 kg·m−2170 (23.7%)1.19 (0.90–1.57)1.15 (0.87–1.52)
          BMI 30.0–34.9 kg·m−2121 (29.3%)1.58 (1.17–2.15)1.57 (1.16–2.14)
          BMI 35.0–39.9 kg·m−236 (23.4%)1.17 (0.76–1.80)1.20 (0.78–1.85)
          BMI >40 kg·m−215 (14%)0.64 (0.36–1.16)0.68 (0.38–1.23)
        Outcomes
         Death
          BMI <18.5 kg·m−21 (3.4%)1.22 (0.16–9.61)0.92 (0.11–7.59)
          BMI 18.5–24.9 kg·m−214 (2.8%)1 (ref.)1 (ref.)
          BMI 25.0–29.9 kg·m−222 (3.1%)1.08 (0.55–2.14)1.09 (0.55–2.18)
          BMI 30.0–34.9 kg·m−214 (3.4%)1.20 (0.56–2.54)1.21 (0.57–2.60)
          BMI 35.0–39.9 kg·m−25 (3.2%)1.15 (0.41–3.23)1.29 (0.45–3.71)
          BMI >40 kg·m−21 (1.0%)0.33 (0.04–2.55)0.53 (0.07–4.18)
         Recurrent VTE
          BMI <18.5 kg·m−21 (3.4%)1.92 (0.24–15.67)1.90 (0.23–15.57)
          BMI 18.5–24.9 kg·m−29 (1.8%)1 (ref.)1 (ref.)
          BMI 25.0–29.9 kg·m−221 (2.9%)1.62 (0.74–3.57)1.55 (0.70–3.42)
          BMI 30.0–34.9 kg·m−214 (3.4%)1.88 (0.81–4.40)1.82 (0.78–4.25)
          BMI 35.0–39.9 kg·m−22 (1.3%)0.71 (0.15–3.30)0.71 (0.15–3.34)
          BMI >40 kg·m−23 (2.9%)1.59 (0.42–5.99)1.41 (0.78–2.53)
         Hospitalisation
          BMI <18.5 kg·m−20 (0%)00
          BMI 18.5–24.9 kg·m−216 (3.3%)1 (ref.)1 (ref.)
          BMI 25.0–29.9 kg·m−234 (4.7%)1.48 (0.81–2.72)1.49 (0.81–2.75)
          BMI 30.0–34.9 kg·m−223 (5.6%)1.75 (0.91–3.37)1.74 (0.90–3.35)
          BMI 35.0–39.9 kg·m−211 (7.1%)2.29 (1.04–5.04)2.39 (1.08–5.32)
          BMI >40 kg·m−25 (4.8%)1.50 (0.54–4.20)1.99 (0.70–5.67)
         Bleeding
          BMI <18.5 kg·m−20 (0%)00
          BMI 18.5–24.9 kg·m−23 (0.6%)1 (ref.)1 (ref.)
          BMI 25.0–29.9 kg·m−27 (1.0%)1.61 (0.41–6.25)1.72 (0.44–6.74)
          BMI 30.0–34.9 kg·m−29 (2.2%)3.63 (0.98–13.50)3.82 (1.02–14.34)
          BMI 35.0–39.9 kg·m−28 (5.2%)8.93 (2.34–34.10)9.99 (2.56–38.92)
          BMI >40 kg·m−23 (2.9%)4.84 (0.96–24.33)7.26 (1.37–38.32)
         All adverse events
          BMI <18.5 kg·m−22 (6.9%)1.23 (0.279–5.43)1.08 (0.24–4.90)
          BMI 18.5–24.9 kg·m−228 (5.7%)1 (ref.)1 (ref.)
          BMI 25.0–29.9 kg·m−247 (6.6%)1.16 (0.72–1.89)1.15 (0.70–1.87)
          BMI 30.0–34.9 kg·m−235 (8.5%)1.53 (0.92–2.57)1.50 (0.89–2.52)
          BMI 35.0–39.9 kg·m−212 (7.8%)1.40 (0.69–2.83)1.47 (0.71–2.94)
          BMI >40 kg·m−27 (6.7%)1.20 (0.51–2.82)1.55 (0.65–3.72)

        BMI <18.5 kg·m−2, n=29; 18.5–24.9 kg·m−2, n=492; 25.0–29.9 kg·m−2, n=716; 30.0–34.9 kg·m−2, n=413; 35.0–39.9 kg·m−2, n=154; >40 kg·m−2, n=104. Ref.: BMI 18.5–24.9 kg·m−2. Proportion was calculated per BMI category with follow-up up to 12 months. NT-proBNP: N-terminal pro-brain natriuretic peptide; sPESI: simplified Pulmonary Embolism Severity Index; RV/LV: right ventricular/left ventricular ratio; DVT: deep vein thrombosis; VTE: venous thromboembolism. #: for age and sex; sPESI only adjusted for sex.

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        Prognostic characteristics and body mass index in patients with pulmonary embolism: does size matter?
        Ludo F.M. Beenen, Luuk J.J. Scheres, Jaap Stoker, Saskia Middeldorp
        ERJ Open Research Jan 2020, 6 (1) 00163-2019; DOI: 10.1183/23120541.00163-2019

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        Prognostic characteristics and body mass index in patients with pulmonary embolism: does size matter?
        Ludo F.M. Beenen, Luuk J.J. Scheres, Jaap Stoker, Saskia Middeldorp
        ERJ Open Research Jan 2020, 6 (1) 00163-2019; DOI: 10.1183/23120541.00163-2019
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