Impact of obesity on clinical outcomes in patients with high-risk pulmonary embolism: A comparative analysis

Background

Pulmonary embolism (PE) is a life-threatening cardiovascular condition with increasing global incidence. Obesity is a significant risk factor for PE, although its reported relationship with outcomes is inconsistent. This study aimed to investigate the impact of obesity on clinical outcomes in patients with high-risk PE.

Methods

We conducted a retrospective analysis of US adult patients hospitalized with high-risk PE from 2016 to 2019 using the National Inpatient Sample database. Patients were categorized into three groups based on BMI: non-obese, obese (30 to < 40 kg/m²), and severely obese (≥40 kg/m²). We compared baseline characteristics, in-hospital procedures, and outcomes among these groups. Multivariable logistic regression models assessed the relationship between obesity levels and in-hospital outcomes.

Results

Of 752,660 patients with PE, 29,610 (3.9 %) were classified as high-risk. The distribution among BMI categories was: non-obese (77.1 %), obese (8.8 %), and severely obese (14.1 %). Severely obese patients were younger (mean age 55.7 vs. 66.1 years for non-obese, p < 0.001) and more likely to be female (63.2 % vs. 51.4 % for non-obese, p < 0.001). After adjustment, obese and severely obese patients had lower odds of in-hospital mortality (obese: aOR 0.50, p < 0.001; severely obese: aOR 0.69, p < 0.001) and major adverse cardiovascular and cerebrovascular events (obese: aOR 0.50, p < 0.001; severely obese: aOR 0.72, p < 0.001).

Conclusion

Our study revealed an “obesity paradox” in high-risk PE patients, with obese and severely obese individuals showing lower mortality and fewer complications despite higher comorbidity rates. These findings emphasize the need for tailored risk assessment and treatment strategies in obese patients with high-risk PE.