(C-020) Paradox Association between Body Mass Index with Occurrence and Fatality of Venous Thromboembolism in Hospitalized Patients: A National Hospital-Based Analysis

Tuesday, August 26, 2025

12:00 PM - 1:30 PM ET

Presenting Author(s)

YL

Yuhao Li

Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Key Laboratory of Epidemiology of Major Diseases, Ministry of Education, China (People's Republic)

Co-Author(s)

LX

Lei Xia

National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, China (People's Republic)
HL

Huiwen Li

National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, China (People's Republic)
DW

Dingyi Wang

National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, China (People's Republic)
ZZ

Zhu Zhang

National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, China (People's Republic)
GF

Guohui Fan

National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, China (People's Republic)
YZ

Yunxia Zhang

National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, China (People's Republic)
SZ

Shuai Zhang

National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, China (People's Republic)
kZ

kaiyuan Zhen

National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, China (People's Republic)
YT

Yuzhi Tao

National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, China (People's Republic)
ZC

Zhaofei Chen

National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, China (People's Republic)
ZZ

Zhenguo Zhai

National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, China (People's Republic)
CS

Chaozeng Si

Department of Pharmacy, China-Japan Friendship Hospital, China (People's Republic)
XZ

Xianbo Zuo

Department of Pharmacy, China-Japan Friendship Hospital, China (People's Republic)
PL

Peng Liu

Department of Cardiovascular Surgery, China-Japan Friendship Hospital, China (People's Republic)
CJ

Cunbo Jia

Hospital Office, China-Japan Friendship Hospital, Beijing, China (People's Republic)

Presenting Author(s)

SW

Shengfeng Wang

Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Key Laboratory of Epidemiology of Major Diseases, Ministry of Education, China (People's Republic)

Background: The association of body mass index (BMI) with venous thromboembolism (VTE) occurrence and post-VTE mortality remains controversial. Some studies suggest that elevated BMI is associated with higher risk of VTE occurrence and mortality, while others indicate a protective effect. Furthermore, evidence for inpatients is lacking.

Objectives: To investigate the association of BMI with VTE occurrence and post-VTE mortality, and explore the consistency across age, sex, and medical specialty (internal medicine or surgery).

Methods:

Design: Nationwide hospital-based cohort study.
Setting: 3,199,526 inpatients at intermediate-high-risk of VTE were included, with data obtained from the Single Disease Quality Monitoring Platform of the National Health Commission of China for 2023.
Exposures or interventions: Lean weight (BMI < 18.5kg/m2), normal weight (18.5≤BMI < 24.0 kg/m2), overweight (24.0≤BMI < 28.0 kg/m2), and obesity (BMI≥28.0 kg/m2).
Main outcome measures: VTE occurrence and post-VTE mortality defined by ICD-10.
Statistical analysis: Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Cox proportional hazards regression models were used for sensitivity analysis.

Results: In this study, 59,002 (1.8%) patients developed VTE during hospitalization. Adjusting for confounding factors, including age, sex, and Padua/Caprini risk scores, compared to normal weight, lean weight was associated with higher risk (OR: 1.18, 95% CI: 1.15-1.22) of VTE occurrence, while the risk of overweight and obesity reduced by 18% (OR: 0.82, 95% CI: 0.80-0.83) and 22% (OR: 0.78, 95% CI: 0.75-0.81), respectively. The protective effect of overweight/obesity was more pronounced in age < 65 years, females, and surgery patients (P interaction < 0.05), whereas in internal medical patients, obesity (OR: 1.11, 95%CI:1.01- 1.21) was associated with a higher risk of VTE occurrence. 636 (1.1%) VTE patients died before discharge. No significant association was observed between overweight/obesity and post-VTE mortality in the overall VTE patients. However, in the surgical subgroup, obesity was significantly associated with a lower risk of post-VTE mortality (OR: 0.37, 95% CI: 0.17-0.80, P interaction < 0.05).

Conclusions: Our study reveals the obesity paradox in the association of BMI with VTE occurrence and post-VTE mortality. These findings emphasize the importance of BMI in VTE risk assessment and suggest that a “one-size-fits-all” approach to VTE prevention may not be appropriate. The need to tailor prevention and treatment strategies to specific patient populations across age, sex, and medical specialty may help improve VTE management and enhance patient prognosis.