Impact of Obesity on Clinical Outcomes in Patients with High-Risk Pulmonary Embolism: A Comparative Analysis

Background: Pulmonary embolism (PE) is a potentially 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 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 (BMI 30 to <40 kg/m²), and morbidly obese (BMI
≥40 kg/m²). We compared baseline characteristics, in-hospital procedures, and clinical outcomes
among these groups. Multivariable logistic regression models were used to assess 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. Morbidly
obese patients were younger (mean age 55.7 years 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
morbidly obese patients had lower odds of in-hospital mortality (obese: aOR 0.50, p 0.001;
morbidly obese: aOR 0.69, ;0.001) and major adverse cardiovascular and cerebrovascular
events (obese: aOR 0.50, p 0.001; morbidly obese: aOR 0.72, p 0.001) compared to non-obese
patients.
Conclusion: Our study revealed an "obesity paradox" in high-risk PE patients, with obese and
morbidly 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