PMID: 39906432 https://pubmed.ncbi.nlm.nih.gov/39906432/

Abstract

BACKGROUND: Pulmonary embolism (PE) is a severe condition often linked to thromboembolic risk factors, such as the prothrombin gene (PGM) G20210A mutation. Although this mutation is a recognized risk factor for venous thromboembolism, little is known about how it affects the clinical course and healthcare utilization of PE patients.

OBJECTIVE: This new study will reveal the complete effect of PGM on clinical outcomes in patients treated for PE, such as hospital stay length, in-hospital death rates, healthcare costs, and associated health conditions. It will also examine how socioeconomic status and demographics impact these outcomes.

METHODS: This retrospective cohort study was conducted using data from the National Inpatient Sample (NIS) from 2016 to 2020. It included adults admitted with a primary diagnosis of PE aged 18 and older. The patients were divided into two groups: those with the PGM mutation and those without. There were two groups where the patients was divided based on their PGM use: those with and those without. Multivariate logistic regression assessed in-hospital mortality, while linear regression models evaluated length of stay (LOS) and healthcare charges. The models were adjusted for demographics, comorbidities (Charlson Comorbidity Index), and hospital characteristics.

RESULTS: Among the 903,230 PE patients, 2,065 (0.2%) had PGM. Patients with the mutation had a significantly lower in-hospital mortality than those without the mutation (adjusted OR 0.13, 95% CI 0.02-0.92, p = 0.041). PGM carriers also had lower rates of atrial fibrillation (5.1% vs. 11.8%, p < 0.001), congestive heart failure (CHF) (5.9% vs. 16.0%, p < 0.001), and chronic obstructive pulmonary disease (COPD) (8.6% vs. 15.5%, p < 0.001), but higher rates of obesity (32.5% vs. 26.1%, p = 0.004) and hyperlipidemia (30.7% vs. 36.0%, p = 0.031). Despite a longer hospital stay in PGM patients (mean difference: 0.52 days, p = 0.005), the difference in total hospital charges was not statistically significant (mean difference: $6,295, p = 0.090).

CONCLUSIONS: Patients with PE and the PGM had lower mortality rates in this national retrospective cohort than those without the mutation. Patients without the PGM presented with more serious comorbidities, including higher rates of atrial fibrillation, CHF, and COPD, which may have contributed to their worse outcomes.