Body Mass Index and In-Hospital Management and Outcomes of Pulmonary Embolism: A Nationwide Analysis

BACKGROUND: Limited data exist on the impact of body mass index (BMI) on the outcomes of admissions with acute pulmonary embolism (PE). METHODS: All adult (≥18 years) admissions with a primary diagnosis of PE were identified using the National Inpatient Sample (2016-2020) and categorized using BMI into underweight (24.9 kg/m 2 ). Outcomes included in-hospital mortality, utilization of PE therapies, and resource utilization. RESULTS: Of 904,260 admissions, 1.8%, 70.4%, and 27.7% were underweight, normal, and overweight/obese, respectively. Underweight admissions were on average older (70.8 ± 0.2, 64.6 ± 0.05, 58.2 ± 0.07 years), male (56.7%, 49%, 58.3%) with higher comorbidity (Elixhauser Index 5.8 ± 0.03, 4 ± 0.06, 5.1 ± 0.09), from a lower socioeconomic status, and with Medicare insurance compared to normal and overweight/obese categories ( P < 0.001). The underweight cohort had higher rates of acute organ failure, bleeding complications, strokes, shock, and higher mechanical ventilation and hemodialysis use. In contrast to the underweight group, normal and overweight/obese groups had higher rates of mechanical thrombectomy (0.3%, 1.1%, 1.9%), systemic thrombolysis (1.5%, 2.6%, 4.2%), catheter directed therapy (0.9%, 3%, 5.8%), and surgical thrombectomy (0.0%, 0.1%, 0.2%) ( P < 0.001). Compared to the normal cohort (3.3%), the underweight cohort had higher [7.8%; odds ratio 1.85 (95% confidence interval 1.54-2.21)], whereas the overweight/obese cohort had lower [2.2%; odds ratio 0.47 (95% confidence interval 0.42-0.52)] in-hospital mortality (both P < 0.001). The underweight cohort had longer hospitalization stays, higher hospitalization costs, and were discharged home less frequently. CONCLUSIONS: Compared to those with normal BMI, underweight status was associated with worse outcomes in those hospitalization with acute PE.