PT - JOURNAL ARTICLE AU - Ludo F.M. Beenen AU - Luuk J.J. Scheres AU - Jaap Stoker AU - Saskia Middeldorp TI - Prognostic characteristics and body mass index in patients with pulmonary embolism: does size matter? AID - 10.1183/23120541.00163-2019 DP - 2020 Jan 01 TA - ERJ Open Research PG - 00163-2019 VI - 6 IP - 1 4099 - http://openres.ersjournals.com/content/6/1/00163-2019.short 4100 - http://openres.ersjournals.com/content/6/1/00163-2019.full SO - erjor2020 Jan 01; 6 AB - 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.Overweight patients with pulmonary embolism have a higher risk of heart dysfunction and worse outcomes http://bit.ly/2Pwtln0