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Thromb Haemost 2024; 124(01): 049-057
DOI: 10.1055/s-0043-57018
Stroke, Systemic or Venous Thromboembolism

Obesity as a Predictor for Pulmonary Embolism and Performance of the Age-Adjusted D-Dimer Strategy in Obese Patients with Suspected Pulmonary Embolism

Jan O. Gaugler 
1   Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
,
Marc Righini
2   Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
,
Helia Robert-Ebadi
2   Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
,
Olivier Sanchez
3   Université Paris Cité, Paris, France
4   Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
5   INSERM UMR S 1140, Innovative Therapies in Hemostasis, Paris, France
,
Pierre-Marie Roy
6   Department of Emergency Medicine, University Hospital of Angers, Angers, France
7   UMR MitoVasc CNRS 6015 - INSERM 1083, Health Faculty, Angers, France
,
Franck Verschuren
8   Emergency Department, Saint-Luc University Hospital, IREC Institute, Université Catholique de Louvain, Brussels, Belgium
,
Sebastien Miranda
9   Department of Internal Medicine, Rouen University Hospital, Normandie University, UNIROUEN, INSERM U1096, Rouen, France.
,
Aurélien Delluc 
10   Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada.
,
Grégoire Le Gal  ‡   *
10   Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada.
,
Tobias Tritschler  ‡   *
1   Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
10   Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada.
› Author Affiliations
Funding The ADJUST-PE study was funded by grant 32003B-130863 from the Swiss National Science Foundation, the 2007 presidential fund from the International Society on Thrombosis and Haemostasis, grant 2010-5 from the Dutch Thrombosis Foundation, and grant PHRC 2011 08-01 from the Projets Hospitaliers de Recherche Clinique, French Ministry of Health. Aurélien Delluc, Grégoire Le Gal, and Tobias Tritschler are members of the Canadian Venous Thromboembolism Research Network (CanVECTOR); the network received grant funding from the Canadian Institutes of Health Research (CDT-142654). Aurélien Delluc is recipient of a University of Ottawa Department of Medicine Research Salary Award. Grégoire Le Gal holds a mid-career clinician scientist award from the Heart and Stroke Foundation of Ontario, and the Chair on the Diagnosis of Venous Thromboembolism, Department of Medicine, University of Ottawa. The funders had no role in the study design, in the collection, analysis, and interpretation of data, in the writing of the manuscript, and in the decision to submit the article for publication.
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Abstract

Introduction Obesity is a risk factor for venous thromboembolism, but studies evaluating its association with pulmonary embolism (PE) in patients with suspected PE are lacking.

Objectives To evaluate whether body mass index (BMI) and obesity (i.e., BMI ≥30 kg/m2) are associated with confirmed PE in patients with suspected PE and to assess the efficiency and safety of the age-adjusted D-dimer strategy in obese patients.

Methods We conducted a secondary analysis of a multinational, prospective study, in which patients with suspected PE were managed according to the age-adjusted D-dimer strategy and followed for 3 months. Outcomes were objectively confirmed PE at initial presentation, and efficiency and failure rate of the diagnostic strategy. Associations between BMI and obesity, and PE were examined using a log-binomial model that was adjusted for clinical probability and hypoxia.

Results We included 1,593 patients (median age: 59 years; 56% women; 22% obese). BMI and obesity were not associated with confirmed PE. The use of the age-adjusted instead of the conventional D-dimer cut-off increased the proportion of obese patients in whom PE was considered ruled out without imaging from 28 to 38%. The 3-month failure rate in obese patients who were left untreated based on a negative age-adjusted D-dimer cut-off test was 0.0% (95% confidence interval: 0.0–2.9%).

Conclusion BMI on a continuous linear scale and obesity were not predictors of confirmed PE among patients presenting with a clinical suspicion of PE. The age-adjusted D-dimer strategy appeared safe in ruling out PE in obese patients with suspected PE.

Keywords

clinical prediction - D-dimer - diagnosis - obesity - pulmonary embolism

Authors' Contribution

Study concept and design: J. O. G., M. R., and G. L. G., T. T.. Provision of study materials or patients: M. R., O. S., P.-M. R., F. V., and G. L. G.. Data analysis: Tobias Tritschler. Drafting of the manuscript: J. O. G., G. L. G., and T. T.. Critical revision of the manuscript for important intellectual content: all authors. Final approval of the manuscript: all authors.


* Contributed equally.


Supplementary Material



Publication History

Received: 22 January 2023

Accepted: 09 March 2023

Article published online:
12 June 2023

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Comment to this article:

Obesity and Pulmonary Embolism: Can We Dismantle the “Obesity Paradox”Thromb Haemost 2024; 124(01): 058-060
DOI: 10.1055/a-2187-0966