Abstract
Objective The aim of this study was to explore the impact of body mass index (BMI) on prognostic indicators and clinical outcomes in patients with pulmonary embolism.
Methods Patients with pulmonary embolism from the Hokusai venous thromboembolism (VTE) randomised clinical trial that compared two anticoagulant regimens were followed-up for 1 year (n=1911). Patients were analysed with regard to World Health Organization (WHO) BMI categories at baseline (underweight (<18.5), normal (18.5 to <25), overweight (25 to <30), obese I (30 to <35), obese II (35 to <40), and obese III (≥40)). Clinical and radiological prognostic characteristics for right ventricular dysfunction and adverse events were assessed with normal weight as a reference. Clinical outcomes were mortality, recurrent VTE, hospitalisation, bleeding and overall adverse events.
Results The relationship between BMI categories and both prognostic parameters and clinical outcomes showed U-shaped curves. Adjusted odds ratios (aORs) were highest in patients who were grade III obese for both clinical parameters (N-terminal pro-brain natriuretic peptide (NT-proBNP) >600 and simplified pulmonary embolism severity index (sPESI)≥1; 2.9 and 1.6), and radiological parameters (pulmonary trunk>29 mm, right-to-left-ventricular ratio>1.0, and central emboli; aOR=4.3, 2.1 and 2.3). Bleeding was observed more frequently in the higher categories of obesity. In patients who were underweight, for NT-proBNP>600 and sPESI≥1 the aORs were 2.6 and 2.5, respectively; however, no major bleeding occurred in this category.
Conclusion Several clinical and radiological prognostics characteristics and right ventricular dysfunction in pulmonary embolism are not evenly distributed among BMI categories. This is reflected in a trend towards worse outcomes in patients who are overweight and underweight.
Abstract
Overweight patients with pulmonary embolism have a higher risk of heart dysfunction and worse outcomes http://bit.ly/2Pwtln0
Footnotes
This article has supplementary material available from openres.ersjournals.com
The Hokusai venous thromboembolism study is registered at www.clinicaltrials.gov with identifier number NCT00986154. Data sharing will be in accordance with the study protocol (Daichii Sankyo), protocol DU176b-D-U305, available as supplementary material for the original publication (N Engl J Med 2013; 369: 1406–1415). The investigator/investigational site will permit study-related monitoring, audits, IRB/IEC review and regulatory inspections by providing direct access to source data/documents. Direct access includes permission to examine, analyse, verify and reproduce any records and reports that are important to the evaluation of a clinical study.
Conflict of interest: L.F.M. Beenen has nothing to disclose.
Conflict of interest: L.J.J. Scheres has nothing to disclose.
Conflict of interest: J. Stoker has nothing to disclose.
Conflict of interest: S. Middeldorp reports grants and personal fees from Daiichi Sankyo, during the conduct of the study; and grants and personal fees from Aspen and Bayer, and personal fees from BMS-Pfizer, Boehringer Ingelheim, Portola and Sanofi, outside the submitted work. All fees were paid to the author's institution.
- Received June 25, 2019.
- Accepted October 29, 2019.
- Copyright ©ERS 2020
This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.