Prognostic characteristics and body mass index in patients with pulmonary embolism: does size matter?. Issue 1 (10th January 2020)

• Record Type: Journal Article
• Authors: Beenen, Ludo F.M.; Scheres, Luuk J.J.; Stoker, Jaap; Middeldorp, Saskia
• Is Part Of: ERJ open research. Volume 6:Issue 1(2020)
• Publication Date: 2020-01-10
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiration -- Periodicals; Respiration; Respiratory organs -- Diseases; Respiratory organs -- Diseases -- Treatment; Respiratory Tract Diseases; Electronic journals; Fulltext; Internet Resources; Periodicals; Periodical; 616.2005
• DOI: 10.1183/23120541.00163-2019
• Languages: English
• ISSNs: 2312-0541

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. Overweight patients with pulmonary embolism have a higher risk of heart dysfunction and worse outcomes http://bit.ly/2Pwtln0