Impact of Cardiovascular-Kidney-Metabolic Syndrome Staging on Clinical Outcomes and
Management of Acute Pulmonary Embolism: A Comprehensive Analysis

Background: Pulmonary embolism (PE) is a life-threatening condition with high morbidity and
mortality rates. Cardiovascular-Kidney-Metabolic (CKM) syndrome, representing a complex
interplay of cardiovascular disease, kidney dysfunction, and metabolic disorders, may
significantly impact PE outcomes. This study investigates the influence of CKM syndrome
staging on clinical outcomes and management strategies in acute PE patients.
Methods: This retrospective study analyzed 725,725 adult patients hospitalized with a primary
diagnosis of PE between 2016 and 2019 using the National Inpatient Sample database. Patients
were categorized based on CKM syndrome stages. Multivariable logistic regression models were
used to assess the relationship between in-hospital outcomes and CKM stages.
Results: As CKM stages advanced, patients exhibited distinct profiles characterized by older
age, male predominance and a higher prevalence of comorbidities. Multivariate analysis revealed
that advanced CKM stages were less likely to receive invasive treatments (systemic
thrombolysis: aOR 0.86, 95% CI 0.81-0.92, p;0.001) but had higher odds of adverse outcomes,
including MACCE (aOR 1.53, 95% CI 1.45-1.60, p;0.001), mortality (aOR 1.33, 95% CI 1.25-
1.41, p;0.001), and major bleeding (aOR 1.15, 95% CI 1.08-1.23, p;0.001).
Conclusion: CKM syndrome staging significantly impacts clinical outcomes and management
strategies in patients with PE. Advanced CKM stages are associated with higher risks of adverse
events, including increased mortality and major bleeding complications. Paradoxically, these
high-risk patients were less likely to receive invasive treatments, highlighting a critical gap in
care.