急性肺栓塞后肥胖的早期死亡率降低和风险预测改善：来自外部验证的多中心队列分析的结果

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis Pub Date : 2025-02-01 DOI:10.1016/j.rpth.2025.102718

Romain Chopard , Laurent Bertoletti , Marc Badoz , Nicolas Meneveau , Fiona Ecarnot , Luciano López Jiménez , Olga Madridano , José Antonio Díaz Peromingo , Meritxell López De la Fuente , Manuel Monreal , Gregory Piazza , RIETE Investigators

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引用次数: 0

摘要

肥胖（定义为体重指数[BMI]≥30 kg/m2）与静脉血栓栓塞死亡率之间的关系仍存在争议。目的：比较肥胖患者和非肥胖、非体重不足患者肺栓塞（PE）后的预后。方法使用前瞻性记录的个体患者数据的多中心注册表，我们分别使用多变量逻辑回归或Cox回归对30天和6个月的结局进行了比较（病因分析）。我们评估了在30天欧洲心脏病学会（ESC）预测算法（预后分析）之上添加BMI信息的增量价值。结果纳入BMI≥18.5 kg/m2的患者2390例(平均年龄66.9±16.8岁；男性1188人[49.7%])；肥胖组686例，占28.7%。肥胖患者的死亡率在30天（3.2% [95% CI, 2.0-4.8]对5.9% [95% CI, 4.8-7.1]）和6个月（8.1% [95% CI, 6.2-10.4]对16.3% [95% CI, 14.6-18.1]）显著低于非肥胖患者。继发性非致死性结局（包括出血、静脉血栓栓塞复发、心肌梗死和中风）的发生率在两组之间没有差异。在ESC预测模型基础上增加肥胖信息，使模型整体拟合和歧视性Harrell C指数从0.636提高到0.657；P = .07)和校准能力（P (Hosmer-Lemeshow) = .02 vs .13），以ESC模型为参考，根据观察到的死亡率进行了显著的重新分类（即10.3%）。研究结果在RIETE注册的35,796例PE患者的外部验证中得到证实。结论：我们提供的证据表明，与非肥胖、非体重不足的患者相比，根据BMI分类为肥胖的患者PE后的早期和中期死亡率较低。BMI应该被纳入预测PE后早期死亡率的算法或评分系统中。

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Lower early mortality and risk prediction improvement of obesity after acute pulmonary embolism: results from a multicenter cohort analysis with external validation

Background

The relationship between obesity (defined as body mass index [BMI] ≥ 30 kg/m²) and mortality in venous thromboembolism remains controversial.

Objectives

We aimed to compare outcomes after pulmonary embolism (PE) between patients with obesity and nonobese, nonunderweight patients.

Methods

Using a multicenter registry of prospectively recorded individual patient data, we compared outcome rates using multivariable logistic or Cox regression for 30-day and 6-month outcomes respectively (etiologic analysis). We assessed the incremental value of adding BMI information on top of the 30-day European Society of Cardiology (ESC) prognostic algorithm (prognostic analysis).

Results

We included 2390 patients with BMI of ≥18.5 kg/m² (mean age, 66.9 ± 16.8 years; 1188 men [49.7%]); 686 patients [28.7%] were in the obese group. Mortality rates were significantly lower in patients with obesity than that in patients who were nonobese at 30 days (3.2% [95% CI, 2.0-4.8] vs 5.9% [95% CI, 4.8-7.1]), and 6 months (8.1% [95% CI, 6.2-10.4] vs 16.3% [95% CI, 14.6-18.1]). Rates of secondary nonfatal outcomes (including bleeding, recurrent venous thromboembolism, myocardial infarction, and stroke) did not differ between groups. The addition of the obesity information on top of the ESC prognostic model improved global model fit and discriminatory (Harrell C index from 0.636 to 0.657; P = .07) and calibration capacities (P (Hosmer–Lemeshow) = .02 vs .13), yielding significant reclassification (ie, 10.3%) based on the observed mortality rates with the ESC model as reference. Findings were confirmed in an external validation using 35,796 patients with PE from the RIETE registry.

Conclusion

We present evidence indicating lower early- and mid-term mortality after PE in patients classified as obese based on BMI, compared with nonobese, nonunderweight patients. BMI should likely be incorporated into algorithms or scoring systems for predicting early mortality following PE.

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