Abstract
BACKGROUND: Pulmonary embolism (PE) is a critical condition with significant morbidity and mortality, particularly among patients with chronic inflammatory diseases (CID) such as rheumatoid arthritis and systemic lupus erythematosus that are linked to a heightened risk of thromboembolic events. METHOD: This retrospective analysis examined 725,725 adult patients hospitalized with a primary diagnosis of PE using the National Inpatient Sample database from 2016 to 2019. Patients were stratified by CID status. The study assessed in-hospital outcomes including all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCE), major bleeding, intracranial hemorrhage, length of stay, and total hospital charges. Multivariable logistic regression models were used to examine the association between CID and in-hospital outcomes, adjusting for baseline differences. RESULTS: Of the study population, 33,775 (4.6 %) had CID. Patients with CID were younger (62.07 vs 62.85 years, p < 0.001) and more likely to be female (69.9 % vs 51.0 %, p < 0.001). After adjustment, patients with CID showed an 8 % decreased mortality risk (aOR 0.92, 95 % CI: 0.86-0.98, p = 0.015) but a 15 % higher risk of major bleeding (aOR 1.15, 95 % CI: 1.08-1.23, p < 0.001). Additionally, there was a small but significant increase in the odds of MACCE for patients with CID (aOR 1.07, 95 % CI: 1.01-1.13, p = 0.014). CONCLUSION: The findings indicate that while patients with CID experience lower in-hospital mortality rates, they are at a greater risk for major bleeding. This underscores the necessity for tailored treatment approaches that consider individual patient factors, such as age and comorbidities, to optimize outcomes in this vulnerable population.