Higher comorbidity burden raises odds for in-hospital mortality in patients with PE
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Key takeaways:
- The likelihood for in-hospital mortality among patients with pulmonary embolism went up with increasing Charlson Comorbidity Index scores.
- High scores also meant elevated odds for sepsis and other outcomes.
HONOLULU — A higher comorbidity burden increases the odds for in-hospital mortality among adults with pulmonary embolism, according to a poster presented at the CHEST Annual Meeting.
The chances for sepsis, shock and mechanical ventilation also went up with a greater measure of underlying disease burden, according to researchers.
“The relationship between patient comorbidities and PE outcomes has not been well described, and current risk stratification does not account for a large portion of these comorbidities,” Andrew Ho, MD, pulmonary and critical care fellow at Temple University Hospital, told Healio. “[In our research,] we are able to show how comorbid disease affects clinical outcomes, and we see stepwise increases in in-hospital mortality, sepsis, shock and need for mechanical ventilation along with increased hospital costs and length of stay.”
Using data from the National Inpatient Sample from 2016 to 2018, Ho and colleagues assessed 561,625 adults hospitalized with PE to determine how comorbidity burden, measured by the Charlson Comorbidity Index (CCI), is related to in-hospital mortality, sepsis, shock and mechanical ventilation.
Researchers divided patients into groups based on their CCI score, including 31.4% with a score of 0 (n = 176,460), 39.8% with a score of 1 or 2 (n = 223,870), 18.2% with a score between 3 and 5 (n = 102,305) and 10.5% with a score of 6 or more (n = 58,990).
As CCI scores went up, researchers observed greater odds for in-hospital mortality vs. a CCI score of 0 (CCI 1-2, adjusted OR = 2.09; 95% CI, 1.86-2.34; CCI 3-5, aOR = 3.12; 95% CI, 2.75-3.55; CCI 6, aOR = 5.44; 95% CI, 4.79-6.12).
“While the expectation was that patients with more underlying disease would have worse outcomes, it was impactful to see the degree by which mortality climbs with increasing comorbidities in a large population reflective of the entire United States,” Ho told Healio. “We also underestimated the extent to which the high-comorbidity patients did not receive advanced therapies beyond standard anticoagulation.”
Increasing CCI scores also heightened the likelihood for sepsis (CCI 1-2, aOR = 2.25; CCI 3-5, aOR = 3.77; CCI 6, aOR = 4.2), shock (CCI 1-2, aOR = 1.79; CCI 3-5, aOR = 2.16; CCI 6, aOR = 2.3) and mechanical ventilation (CCI 1-2, aOR = 1.96; CCI 3-5, aOR = 2.52; CCI 6, aOR = 2.84), according to the poster.
“Further studies will need to assess how comorbidity burden impacts longer-term mortality in PE as our data are limited to what is provided by the database,” Ho told Healio. “That would allow us to compare the effect of comorbidities in acute PE vs. other disease processes in terms of expected mortality. We will also need to see what comes out of the studies revolving around advanced therapies for PE and their safety profiles, as our high-comorbidity patients clearly have higher short-term mortality and may derive more benefit from these treatments.
“At the Temple Lung Center, we see a lot of heterogeneity in PE patients, especially in the intermediate-risk group, and integrating a patients' underlying disease may help to further subcategorize these patients,” Ho added.