Association of Body Mass Index with D-Dimer Levels and Severity Markers in Patients with Confirmed Pulmonary Embolism: A BMI-Stratified Analysis of Clinical, Radiological, and Hemodynamic Determinants

Abstract

Objectives: This study aimed to evaluate the association between body mass index (BMI) and D-dimer levels and to examine the clinical, radiological, and hemodynamic determinants of D-dimer variability within BMI strata among patients with confirmed pulmonary embolism. Methodology: This retrospective cross-sectional analytical study included adult patients (≥18 years) with computed tomography pulmonary angiography (CTPA)-confirmed pulmonary embolism, documented anthropometric measurements, and D-dimer testing performed within 24 hours of diagnosis. BMI was categorized according to World Health Organization criteria D-dimer concentrations were measured using a latex-enhanced immunoturbidimetric assay. Results: A total of 153 patients were included (mean age 48.03 ± 15.49 years; 50.98% male). The mean BMI was 27.74 ± 6.14 kg/m², with 36.60% of participants classified as overweight and 30.72% as obese. The median D-dimer concentration was 6035.03 ng/mL (IQR: 4535.59–7534.47). D-dimer levels increased progressively across BMI categories (p < 0.001). Within BMI strata, most presenting symptoms and electrocardiographic findings were not significantly associated with D-dimer levels. In contrast, objective indicators of disease severity demonstrated significant associations. Oxygen saturation categories were associated with D-dimer levels in normal-weight and obese patients, Wells score was associated with D-dimer levels in overweight patients, and concomitant deep vein thrombosis was associated with higher D-dimer concentrations in overweight and obese groups. Among obese patients, significant associations were also observed between D-dimer levels and CTPA thrombus distribution, right ventricular enlargement, and pulmonary arterial hypertension severity. Conclusion: D-dimer concentrations increase progressively with increasing BMI among patients with confirmed pulmonary embolism. After BMI stratification, D-dimer levels appear to correlate more closely with objective markers of thrombotic burden, cardiopulmonary compromise, and right ventricular strain than with presenting symptoms.