OC 11.3 - Association between body mass index and pulmonary embolism and performance of the age-adjusted D-dimer strategy in obese patients with suspected pulmonary embolism: a prospective management study

Sunday, June 25, 2023

11:15 – 11:30 ET

Room: 516

Session Available As: Live-Stream and On-Demand

Co-Author(s)

JG

Jan O. Gaugler

Student
Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Bern, Bern, Switzerland
Marc Righini, MD

MD
Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
Geneve, Geneve, Switzerland
Helia Robert-Ebadi, MD

MD
Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
Geneva, Geneve, Switzerland
Olivier Sanchez, MD, PhD

Head of department
Université Paris Cité, Service de Pneumologie et Soins Intensifs, HEGP
Paris, France
Pierre-Marie Roy, MD, PhD (he/him/his)

MD, PhD
Service des urgences, Centre Hospitalo-Universitaire d’Angers, Institut MITOVASC, EA 3860, Université d'Angers, Angers, FCRIN INNOVTE, France.
Angers, Pays de la Loire, France
FV

Franck Verschuren

MD, PhD
Université Catholique de Louvain, IREC Institute, Emergency Department, Saint-Luc University Hospital, Brussels, Belgium
Brussels, Brussels Hoofdstedelijk Gewest, Belgium
SM

Sebastien Miranda

MD, PhD
Normandie University, UNIROUEN, INSERM U1096, Rouen University Hospital, Rouen, France
Rouen, Haute-Normandie, France
AD

Aurélien Delluc

Professor, MD, PhD
Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
Ottawa, Ontario, Canada
Gregoire Le Gal, MD PhD

MD, PhD
Ottawa Hospital Research Institute, University of Ottawa, Canada
Ottawa, Ontario, Canada

Presenting Author(s)

Tobias Tritschler, MD, MSc

MD, MSc
Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Bern, Bern, Switzerland

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

Aims: 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 (ADJUST-PE), 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 at initial presentation were examined using a log-binomial model that was adjusted for clinical probability and hypoxia. Efficiency was defined as the number of patients with a low/intermediate clinical probability and negative age-adjusted D-dimer test result relative to the total number of patients. Failure rate was defined as the proportion of patients with symptomatic VTE during follow-up in whom PE was considered ruled out based on negative age-adjusted D-dimer test result.

Results: We included 1593 patients (median age, 59 years; 56% women; 22% obese). BMI and obesity were not associated with confirmed PE (Table). The use of the age-adjusted instead of the conventional D-dimer cut-off increased efficiency 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%) (Figure).

Conclusion(s): 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.

Learning Objectives:

Upon completion, participants will be able to describe the association of obesity and objectively confirmed pulmonary embolism (PE) in a prospective management study of patients with suspected PE.
Upon completion, participants will be able to describe the efficiency of the age-adjusted D-dimer strategy in obese patients with a clinical suspicion of PE.
Upon completion, participants will be able to describe the failure rate of the age-adjusted D-dimer strategy in obese patients with a clinical suspicion of PE.