Introduction: Electronic cigarettes may expose users to fewer toxic compounds than combustible tobacco, suggesting they could serve as a harm-reduction tool for smokers. Unfortunately, some users misinterpreted this information, using e-cigarettes as a “safe” alternative. Emerging evidence highlights potential harms, including endothelial dysfunction, oxidative stress, nitric oxide depletion, platelet activation, sympathetic stimulation, and a pro-inflammatory state. Despite these risks, government regulation remains inadequate, and its impact—particularly in patients with pulmonary embolism—remains uncertain. Methods: We conducted a retrospective analysis using data from the 2020–2022 National Inpatient Sample (NIS) database. Patients with pulmonary embolism and concurrent e-cigarette use were identified via validated ICD-10 codes. Multivariate logistic regression adjusted for confounders including sex, age, race, cigarette smoking, obesity, and comorbidity burden (Charlson and Elixhauser Indices). Statistical analyses were performed using STATA 18. Results: A total of 109, 979 patients were admitted with a primary diagnosis of pulmonary embolism, of whom 2. 69% (n = 2, 969) reported concurrent e-cigarette use. The mean age of e-cigarette users was 62 years, compared to 64 years in non-users (p < 0. 001). Females accounted for 47% of the user group. Patients with concurrent e-cigarette use exhibited significantly higher in-hospital mortality (OR: 1. 89; 95% CI: 1. 39–2. 57; p < 0. 001), increased use of high-flow nasal cannula (OR: 2. 92; 95% CI: 1. 07–5. 11; p = 0. 03), greater need for mechanical ventilation (OR: 1. 91; 95% CI: 1. 43–2. 56; p < 0. 001), and more frequent use of extracorporeal membrane oxygenation (OR: 2. 33; 95% CI: 1. 48–3. 65; p < 0. 001). Additionally, this group had a significantly longer hospital stay (mean: 5. 87 vs. 4. 41 days; 95% CI: 1. 26–1. 65; p < 0. 001) and incurred higher hospitalization costs (mean: 75, 417 vs. 61, 683; p < 0. 001). Conclusions: E-cigarette use is linked to more severe outcomes in patients with pulmonary embolism, including higher mortality, greater need for respiratory support, longer hospitalizations, and increased costs. It should be considered a potential risk factor in clinical management, warranting further research into its harmful effects and prevention strategies.
ORTEGA et al. (Sun,) studied this question.