# Impact of cardiovascular-kidney-metabolic syndrome staging on clinical outcomes and management of acute pulmonary embolism: A comprehensive analysis

## TL;DR

This study shows that higher stages of cardiovascular-kidney-metabolic syndrome are linked to worse outcomes and less treatment in patients with pulmonary embolism.

## Contribution

The study introduces the use of CKM syndrome staging to predict outcomes and treatment patterns in acute pulmonary embolism patients.

## Key findings

- Advanced CKM stages are associated with higher mortality and bleeding risks in PE patients.
- Patients with higher CKM stages are less likely to receive invasive treatments for PE.
- CKM staging reveals significant care gaps in managing high-risk PE patients.

## Abstract

•Advanced CKM stages worsen outcomes in pulmonary embolism patients.•High CKM stages linked to less use of invasive PE treatments.•CKM staging predicts PE mortality, bleeding, and adverse events.•PE patients with CKM have longer hospital stays and higher costs.•Study of 725,000 PE patients reveals care gaps by CKM stage.

Advanced CKM stages worsen outcomes in pulmonary embolism patients.

High CKM stages linked to less use of invasive PE treatments.

CKM staging predicts PE mortality, bleeding, and adverse events.

PE patients with CKM have longer hospital stays and higher costs.

Study of 725,000 PE patients reveals care gaps by CKM stage.

Pulmonary embolism (PE) is a life-threatening condition with high morbidity and mortality rates. Cardiovascular-Kidney-Metabolic (CKM) syndrome, representing a complex interplay of cardiovascular disease, kidney dysfunction, and metabolic disorders, may significantly impact PE outcomes. This study investigates the influence of CKM syndrome staging on clinical outcomes and management strategies in acute PE patients.

This retrospective study analyzed 725,725 adult patients hospitalized with a primary diagnosis of PE between 2016 and 2019 using the National Inpatient Sample database. Patients were categorized into five CKM groups (0,1,2/3,4a, 4b) based on staging criteria. Multivariable logistic regression models were used to assess the relationship between in-hospital outcomes and CKM stages.

As CKM stages advanced, patients exhibited distinct profiles characterized by older age, male predominance and a higher prevalence of comorbidities. Multivariate analysis revealed that advanced CKM stages were less likely to receive invasive treatments (systemic thrombolysis: aOR 0.86, 95 % CI 0.81–0.92, p < 0.001) but had higher odds of adverse outcomes, including MACCE (aOR 1.53, 95 % CI 1.45–1.60, p < 0.001), mortality (aOR 1.33, 95 % CI 1.25–1.41, p < 0.001), and major bleeding (aOR 1.15, 95 % CI 1.08–1.23, p < 0.001). All odds ratios were computed using CKM stage 0 as the reference group.

CKM syndrome staging significantly impacts clinical outcomes and management strategies in patients with PE. Advanced CKM stages are associated with higher risks of adverse events, including increased mortality and major bleeding complications. Paradoxically, these high-risk patients were less likely to receive invasive treatments, highlighting a critical gap in care.