Diabetes mellitus and its impact on mortality rate and outcome in pulmonary embolism.

Abstract

AIMS/INTRODUCTION:

In patients with pulmonary embolism (PE), the impact of diabetes mellitus on patient profile and outcome is not well investigated.

MATERIAL AND METHODS:

The German nationwide inpatient sample of the years 2005-2018 was analyzed. Hospitalized PE patients were stratified for diabetes, and the impact of diabetes on in-hospital events was investigated.

RESULTS:

Overall, 1,174,196 PE patients (53.8% aged ≥70 years, 53.5% women) and, among these, 219,550 (18.7%) diabetes patients were included. In-hospital mortality rate amounted to 15.8%, and was higher in diabetes patients than in non-diabetes patients (19.8% vs 14.8%, P < 0.001). PE patients with diabetes had a higher prevalence of cardiovascular risk factors, comorbidities, right ventricular dysfunction (31.8% vs 27.7%, P < 0.001), prolonged in-hospital stay (11.0 vs 9.0 days, P < 0.001) and higher rates of adverse in-hospital events. Remarkably, diabetes was independently associated with increased in-hospital mortality (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.20-1.23, P < 0.001) when adjusted for age, sex and comorbidities. Within the observation period of 2005-2018, a relevant decrease of in-hospital mortality in PE patients with diabetes was observed (25.5% to 16.8%). Systemic thrombolysis was more often administered to diabetes patients (OR 1.18, 95% CI 1.01-3.49, P < 0.001), and diabetes was associated with intracerebral (OR 1.19, 95% CI 1.12-1.26, P < 0.001), as well as gastrointestinal bleeding (OR 1.11, 95% CI 1.07-1.15, P < 0.001). Type 1 diabetes mellitus was shown to be a strong risk factor in PE patients for shock, right ventricular dysfunction, cardiopulmonary resuscitation and in-hospital death (OR 1.75, 95% CI 1.61-1.90, P < 0.001).

CONCLUSIONS:

Despite the progress in diabetes treatments, diabetes is still associated with an unfavorable clinical patient profile and higher risk for adverse events, including substantially increased in-hospital mortality in acute PE.

• Authors: Volker H Schmitt, Lukas Hobohm, Visvakanth Sivanathan, Christoph Brochhausen, Tommaso Gori, Thomas Münzel, Stavros V Konstantinides, Karsten Keller
• Journal: Journal of diabetes investigation (J Diabetes Investig) Vol. 13 Issue 4 Pg. 725-737 (Apr 2022) ISSN: 2040-1124 [Electronic] Japan
• PMID: 34779148 (Publication Type: Journal Article)
• Copyright: © 2021 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

Topics

• Acute Disease
• Aged, 80 and over
• Diabetes Mellitus (epidemiology)
• Female
• Germany (epidemiology)
• Hospital Mortality
• Humans
• Male
• Pulmonary Embolism (complications, epidemiology, therapy)
• Retrospective Studies
• Risk Factors
• Thrombolytic Therapy (statistics & numerical data)
• Ventricular Dysfunction, Right