Chilingarashvili, Giorgi

Background: Studies in the past have demonstrated an association between sarcoidosis and pulmonary embolism (PE), but little is known about its impact, especially in young adults. We aim to determine the burden and impact of PE in young adults hospitalized with sarcoidosis. Methods: This study investigates the prevalence and consequences of PE in young adults aged 18–44 years hospitalized with sarcoidosis using data from the National Inpatient Sample (2016–2020) with relevant International Classification of Diseases (ICD)-10 codes. This study aims to address the primary outcomes of the burden and trends of PE and its associated impact on in-hospital mortality. Additionally, it explores secondary outcomes such as healthcare resource utilization and discharge patterns. Results: Among 50,385 young adults (median age 37 years) hospitalized with sarcoidosis, 1120 had PE, showing a linear increase from 2% in 2016 to 2.9% ( P < 0.001) in 2020. The sarcoidosis–PE+ group, predominantly in young blacks, exhibited a higher prevalence of comorbidities such as obesity, smoking, drug use, peripheral vascular disease, hypothyroidism and prior history of venous thrombus embolism. In contrast, the sarcoidosis–PE− group had a higher prevalence of diabetes (with/without chronic complication), hyperlipidemia and chronic pulmonary disease. Multivariable regression analysis adjusted for all potential sociodemographic and comorbid variables showed higher odds of all-cause mortality (odds ratio [OR]: 2.92, 95% confidence interval [CI]: 1.18–7.24, P < 0.02) in the sarcoidosis–PE+ group as compared to the sarcoidosis–PE− group. The sarcoidosis–PE+ group also had higher hospital costs and length of stay. Conclusion: The higher odds of in-hospital mortality with an increased length of stay and hospital cost observed in the sarcoidosis–PE+ group highlight the often underreported complications of sarcoidosis, particularly in a younger demographic. The relevance of this study stems from its potential to uncover trends that could lead to improved diagnostic and therapeutic strategies.

Purpose: Obesity is a risk factor for sepsis complications in older adults. We assessed the impact of metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO) on outcomes in septic shock. Methods: We conducted a retrospective analysis using the National Inpatient Sample (2016-2020) to identify a cohort of 1,737,075 patients aged 65 years and older who were hospitalized with septic shock, as defined by ICD-10 diagnosis codes. Obese patients without hypertension, diabetes, or hyperlipidemia were classified as MHO; those with ≥1 risk factor as MUHO. Baseline demographics and hospital characteristics were compared using χ² and Mann–Whitney U tests. Multivariable logistic regression adjusted for age, sex, race, comorbidity index, and hospital factors estimated odds ratios (ORs) for respiratory failure, mechanical ventilation, in-hospital mortality, and cardiac arrest. Secondary endpoints included length of stay (LOS) and hospitalization cost. Results: Among 268 050 obese patients, 23 915 (1.4%) were classified as MHO and 244 135 (14.1%) as MUHO. Both phenotypes were more prevalent in females and least common among Asian patients. MHO prevalence was highest among Native Americans, while MUHO was most common among Hispanics in 2020. From 2016 to 2019, the prevalence of both phenotypes remained stable, with modest increases observed during the 2020 sepsis surge. Respiratory failure occurred most frequently in the MHO group (∼70%), followed by MUHO (∼65%) and non-obese patients (∼60%). After adjusting for confounders, both MHO and MUHO groups had higher odds of respiratory failure and mechanical ventilation compared to non-obese patients. In-hospital mortality increased across all groups in 2020; however, MUHO patients had lower adjusted mortality risk. Cardiac arrest rates remained unchanged, while length of stay and hospitalization costs were highest among MHO patients. Conclusions: MHO and MUHO both confer higher respiratory failure and ventilation risk; lower mortality in MUHO warrants further study. Clinical Implications Phenotypic obesity classification may improve sepsis risk stratification and inform metabolic-specific management.