{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:07:43Z","timestamp":1792789663422,"version":"4.5.0"},"reference-count":86,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Victor Babe\u0219 University of Medicine and Pharmacy Timi\u0219oara","id":[{"id":"https:\/\/ror.org\/00afdp487","id-type":"ROR","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/00afdp487","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Modifiable lifestyle factors are established determinants of venous thromboembolism risk, but their relationship with the severity and early course of acute pulmonary embolism (PE) is poorly characterized, and no validated Romanian-language instrument captures these domains in the acute PE setting. This protocol describes a prospective observational study with two distinct components: (i) a measurement component that develops and validates the Pulmonary Embolism Lifestyle and Nutrition Questionnaire (PE-LNQ), a composite patient-completed instrument, and (ii) a clinical component that analyzes the associations between lifestyle factors, routine clinical and laboratory data, and the severity and early outcomes of acute PE. Methods: Phase 1 comprises cross-cultural adaptation, content validation, piloting, and COSMIN-based psychometric evaluation. Its primary endpoints are test\u2013retest reliability (ICC \u2265 0.70) and confirmation of \u226575% of a priori construct-validity hypotheses, including convergent validity against measured anthropometry and routine biomarkers. Phase 2 enrolls consecutive adults with CTPA-confirmed acute PE in a staged design (minimum 220 patients single-center; approximately 400 with a planned multicenter extension). The primary clinical endpoint is intermediate-\/high-risk PE (vs. low risk) by sPESI\/PESI, with the ordinal PESI class (I\u2013V) as the key secondary endpoint. Severity data and a pre-specified panel of routine admission laboratory parameters are extracted from the medical record without study-specific sampling; patients are followed for in-hospital, 3-, and 6-month adverse events. The confirmatory analysis is multivariable logistic regression; ordinal, survival, incremental-value, and biomarker analyses are pre-specified as secondary or exploratory. Expected Results: The PE-LNQ is expected to show adequate reliability and validity, and less favorable lifestyle profiles to be associated with higher severity class and more early adverse events. Conclusions: This study will deliver a validated, freely reusable instrument and clarify the prognostic relevance of modifiable lifestyle factors, supporting their integration into risk assessment and secondary prevention.<\/jats:p>","DOI":"10.3390\/jcm15197573","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:14:37Z","timestamp":1790694877000},"page":"7573","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lifestyle, Dietary Habits, and Modifiable Risk Factors in Patients with Acute Pulmonary Embolism: Protocol for a Prospective Observational Study with Development and Validation of a Composite Lifestyle and Nutrition Questionnaire"],"prefix":"10.3390","volume":"15","author":[{"given":"Carina","family":"Gib","sequence":"first","affiliation":[{"name":"Doctoral School, Victor Babe\u0219 University of Medicine and Pharmacy Timi\u0219oara, Eftimie Murgu Square, No. 2, 300041 Timi\u0219oara, Romania"},{"name":"Center of Advanced Research in Cardiology and Hemostasology, Victor Babe\u0219 University of Medicine and Pharmacy Timi\u0219oara, Eftimie Murgu Square, No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3818-5261","authenticated-orcid":false,"given":"Alina","family":"Anton","sequence":"additional","affiliation":[{"name":"Department of Toxicology, Victor Babe\u0219 University of Medicine and Pharmacy Timi\u0219oara, Eftimie Murgu Square, No. 2, 300041 Timi\u0219oara, Romania"},{"name":"Research Centre for Pharmaco-Toxicological Evaluation, Victor Babe\u0219 University of Medicine and Pharmacy Timi\u0219oara, Eftimie Murgu Square, No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5219-5466","authenticated-orcid":false,"given":"Andreea-Adriana","family":"Neam\u021bu","sequence":"additional","affiliation":[{"name":"Department of Toxicology, Victor Babe\u0219 University of Medicine and Pharmacy Timi\u0219oara, Eftimie Murgu Square, No. 2, 300041 Timi\u0219oara, Romania"},{"name":"Research Centre for Pharmaco-Toxicological Evaluation, Victor Babe\u0219 University of Medicine and Pharmacy Timi\u0219oara, Eftimie Murgu Square, No. 2, 300041 Timi\u0219oara, Romania"},{"name":"Department of Pathology, Clinical County Emergency Hospital of Arad, Andrenyi Karoly Str., No. 2\u20134, 310037 Arad, Romania"},{"name":"Department of Pathology, \u201cPius Brinzeu\u201d Clinical County Emergency Hospital Timi\u0219oara, Liviu Rebreanu Boulevard, No. 156, 300723 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teodor-Andrei","family":"Maghiar","sequence":"additional","affiliation":[{"name":"Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Universit\u0103\u021bii Str., No. 1, 410087 Oradea, Romania"},{"name":"Department of Surgery, Pelican Hospital, Corneliu Coposu Str., No. 2, 410450 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raluca-Andreea","family":"Jupaneant","sequence":"additional","affiliation":[{"name":"Doctoral School, Victor Babe\u0219 University of Medicine and Pharmacy Timi\u0219oara, Eftimie Murgu Square, No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8901-8271","authenticated-orcid":false,"given":"Laura","family":"Maghiar","sequence":"additional","affiliation":[{"name":"Department of Psycho-Neurosciences and Rehabilitation, Faculty of Medicine and Pharmacy, University of Oradea, Universit\u0103\u021bii Str., No. 1, 410087 Oradea, Romania"},{"name":"Department of Dermatovenerology, Clinical County Emergency Hospital Bihor, 410169 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teodora Maria","family":"Bodog","sequence":"additional","affiliation":[{"name":"Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Universit\u0103\u021bii Str., No. 1, 410087 Oradea, Romania"},{"name":"Bihor County Emergency Clinical Hospital, 410169 Oradea, Romania"},{"name":"Doctoral School of Biomedical Sciences, University of Oradea, Universit\u0103\u021bii Str., No. 1, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7489-4811","authenticated-orcid":false,"given":"Emanuel Ionu\u021b","family":"Poplicean","sequence":"additional","affiliation":[{"name":"Doctoral School, Victor Babe\u0219 University of Medicine and Pharmacy Timi\u0219oara, Eftimie Murgu Square, No. 2, 300041 Timi\u0219oara, Romania"},{"name":"Center of Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), Victor Babe\u0219 University of Medicine and Pharmacy Timi\u0219oara, Eftimie Murgu Square, No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ion-Costel","family":"Epuras","sequence":"additional","affiliation":[{"name":"Doctoral School, Victor Babe\u0219 University of Medicine and Pharmacy Timi\u0219oara, Eftimie Murgu Square, No. 2, 300041 Timi\u0219oara, Romania"},{"name":"Oftalmo Sensory-Tumor Research Center\u2013ORL (EYE-ENT), Victor Babe\u0219 University of Medicine and Pharmacy Timi\u0219oara, Eftimie Murgu Square, No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Octavian","family":"Cre\u021bu","sequence":"additional","affiliation":[{"name":"Department of Surgery I\u2014Clinic of Surgical Semiotics & Thoracic Surgery, Victor Babe\u0219 University of Medicine and Pharmacy Timi\u0219oara, Eftimie Murgu Square, No. 2, 300041 Timi\u0219oara, Romania"},{"name":"Center for Hepato-Biliary and Pancreatic Surgery, Victor Babe\u0219 University of Medicine and Pharmacy Timi\u0219oara, Eftimie Murgu Square, No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Florin","family":"Lighezan","sequence":"additional","affiliation":[{"name":"Center of Advanced Research in Cardiology and Hemostasology, Victor Babe\u0219 University of Medicine and Pharmacy Timi\u0219oara, Eftimie Murgu Square, No. 2, 300041 Timi\u0219oara, Romania"},{"name":"Department of Internal Medicine I, Victor Babe\u0219 University of Medicine and Pharmacy Timi\u0219oara, Eftimie Murgu Square, No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1056\/NEJMcp2116489","article-title":"Pulmonary Embolism","volume":"387","author":"Kahn","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1161\/ATVBAHA.124.320151","article-title":"Global Health Burden of Venous Thromboembolism","volume":"44","author":"Wendelboe","year":"2024","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1093\/eurheartj\/ehz405","article-title":"2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)","volume":"41","author":"Konstantinides","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1038\/s41569-022-00787-6","article-title":"Epidemiology and prevention of venous thromboembolism","volume":"20","author":"Lutsey","year":"2023","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/S2213-2600(19)30354-6","article-title":"Trends in mortality related to pulmonary embolism in the European Region, 2000\u201315: Analysis of vital registration data from the WHO Mortality Database","volume":"8","author":"Barco","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"103389","DOI":"10.1016\/j.eclinm.2025.103389","article-title":"Global trends in mortality related to pulmonary embolism: An epidemiological analysis of data from the World Health Organization mortality database from 2001 to 2023","volume":"86","author":"Hagiya","year":"2025","journal-title":"eClinicalMedicine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1001\/jama.2022.16815","article-title":"Acute Pulmonary Embolism: A Review","volume":"328","author":"Freund","year":"2022","journal-title":"JAMA"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1620","DOI":"10.1016\/j.jacc.2025.12.023","article-title":"2026 Acute Pulmonary Embolism Guideline-at-a-Glance","volume":"87","author":"Dudzinski","year":"2026","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1016\/j.chest.2024.03.003","article-title":"Antithrombotic Therapy for VTE Disease: Compendium and Review of CHEST Guidelines 2012\u20132021","volume":"166","author":"Stevens","year":"2024","journal-title":"Chest"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1164\/rccm.200506-862OC","article-title":"Derivation and validation of a prognostic model for pulmonary embolism","volume":"172","author":"Aujesky","year":"2005","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1001\/archinternmed.2010.199","article-title":"Simplification of the Pulmonary Embolism Severity Index for prognostication in patients with acute symptomatic pulmonary embolism","volume":"170","author":"Aujesky","year":"2010","journal-title":"Arch. Intern. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.ejim.2024.01.037","article-title":"Performance of the Simplified Pulmonary Embolism Severity Index in predicting 30-day mortality after acute pulmonary embolism: Validation from a large-scale cohort","volume":"124","author":"Zhang","year":"2024","journal-title":"Eur. J. Intern. Med."},{"key":"ref_13","first-page":"3899","article-title":"The Prognostic Value of Troponin in Acute Pulmonary Embolism: A Systematic Review and Meta-Analysis","volume":"106","author":"Elmewafy","year":"2025","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e70107","DOI":"10.1111\/echo.70107","article-title":"Diagnostic and Prognostic Value of RV Strain Defined as RV\/LV Ratio on Chest CT in Acute Pulmonary Embolism: A Systematic Review","volume":"42","author":"Hanmandlu","year":"2025","journal-title":"Echocardiography"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1007\/s11239-023-02929-0","article-title":"Computed tomography-based radiomics model to predict adverse clinical outcomes in acute pulmonary embolism","volume":"57","author":"Yang","year":"2024","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Li, Y., Zhang, L., Liu, H., Li, Y., and Liu, Z. (2025). Research progress of artificial intelligence and machine learning in pulmonary embolism. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1577559"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.annemergmed.2012.10.022","article-title":"Prognostic value of plasma lactate levels among patients with acute pulmonary embolism: The thrombo-embolism lactate outcome study","volume":"61","author":"Vanni","year":"2013","journal-title":"Ann. Emerg. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1136\/thoraxjnl-2014-206300","article-title":"Short-term clinical outcome of normotensive patients with acute PE and high plasma lactate","volume":"70","author":"Vanni","year":"2015","journal-title":"Thorax"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1164\/rccm.201003-0481OC","article-title":"Prognostic importance of hyponatremia in patients with acute pulmonary embolism","volume":"182","author":"Scherz","year":"2010","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"25","DOI":"10.2337\/dc11-1379","article-title":"Elevated admission glucose and mortality in patients with acute pulmonary embolism","volume":"35","author":"Scherz","year":"2012","journal-title":"Diabetes Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1136\/heartjnl-2012-301884","article-title":"Neutrophil gelatinase-associated lipocalin, cystatin C and eGFR indicate acute kidney injury and predict prognosis of patients with acute pulmonary embolism","volume":"98","author":"Kostrubiec","year":"2012","journal-title":"Heart"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.arbres.2024.03.024","article-title":"C-Reactive Protein and Risk of Right Ventricular Dysfunction and Mortality in Patients with Acute Symptomatic Pulmonary Embolism","volume":"60","author":"Najarro","year":"2024","journal-title":"Arch. Bronconeumol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1177\/00033197241226881","article-title":"Serum Albumin for Short-Term Poor Prognosis in Patients with Acute Pulmonary Embolism: A Clinical Study Based on a Database","volume":"76","author":"Qiu","year":"2025","journal-title":"Angiology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1111\/crj.13227","article-title":"Red cell distribution width for prognosis in patients with pulmonary embolism: A systematic review and meta-analysis","volume":"14","author":"Xing","year":"2020","journal-title":"Clin. Respir. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"4","DOI":"10.23736\/S0392-9590.17.03848-2","article-title":"Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute pulmonary embolism: A systematic review and meta-analysis","volume":"37","author":"Wang","year":"2018","journal-title":"Int. Angiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1161\/CIRCULATIONAHA.107.709204","article-title":"Cardiovascular risk factors and venous thromboembolism: A meta-analysis","volume":"117","author":"Ageno","year":"2008","journal-title":"Circulation"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1161\/ATVBAHA.118.312338","article-title":"Smoking and Increased White and Red Blood Cells: A Mendelian Randomization Approach in the Copenhagen General Population Study","volume":"39","author":"Pedersen","year":"2019","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez-Gonz\u00e1lez, M.A., Garc\u00eda-Arellano, A., Toledo, E., Salas-Salvad\u00f3, J., Buil-Cosiales, P., Corella, D., Covas, M.I., Schr\u00f6der, H., Ar\u00f3s, F., and G\u00f3mez-Gracia, E. (2012). A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: The PREDIMED trial. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0043134"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Zawadzka, P.S., Imiela, A.M., and Pruszczyk, P. (2025). The Interplay Between Obesity and Venous Thromboembolism: From Molecular Aspects to Clinical Issue. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms262110292"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1007\/s10654-019-00579-2","article-title":"Physical activity and risk of venous thromboembolism: Systematic review and meta-analysis of prospective cohort studies","volume":"35","author":"Kunutsor","year":"2020","journal-title":"Eur. J. Epidemiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"22088","DOI":"10.1038\/s41598-024-73616-0","article-title":"Role of physical activity and sedentary behavior in venous thromboembolism: A systematic review and dose-response meta-analysis","volume":"14","author":"Wang","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2831","DOI":"10.1016\/j.numecd.2021.06.021","article-title":"Anti-inflammatory diet and venous thromboembolism: Two prospective cohort studies","volume":"31","author":"Yuan","year":"2021","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1016\/j.clnu.2023.06.016","article-title":"Ultra-processed food intake and incident venous thromboembolism risk: Prospective cohort study","volume":"42","author":"Yuan","year":"2023","journal-title":"Clin. Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e077310","DOI":"10.1136\/bmj-2023-077310","article-title":"Ultra-processed food exposure and adverse health outcomes: Umbrella review of epidemiological meta-analyses","volume":"384","author":"Lane","year":"2024","journal-title":"BMJ"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Laffond, A., Rivera-Pic\u00f3n, C., Rodr\u00edguez-Mu\u00f1oz, P.M., Ju\u00e1rez-Vela, R., Ruiz de Vi\u00f1aspre-Hern\u00e1ndez, R., Navas-Echazarreta, N., and S\u00e1nchez-Gonz\u00e1lez, J.L. (2023). Mediterranean Diet for Primary and Secondary Prevention of Cardiovascular Disease and Mortality: An Updated Systematic Review. Nutrients, 15.","DOI":"10.3390\/nu15153356"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"104154","DOI":"10.1016\/j.ebiom.2022.104154","article-title":"Appraising the causal role of smoking in multiple diseases: A systematic review and meta-analysis of Mendelian randomization studies","volume":"82","author":"Larsson","year":"2022","journal-title":"eBioMedicine"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1093\/pubmed\/fdab045","article-title":"Meta-analysis of alcohol consumption and venous thromboembolism","volume":"44","author":"Zhang","year":"2022","journal-title":"J. Public Health"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Lin, T., Mao, H., and Jin, Y. (2024). Caffeinated beverages intake and risk of deep vein thrombosis: A Mendelian randomization study. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0298123"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1136\/heartjnl-2024-325030","article-title":"Cardiovascular health effects of vaping e-cigarettes: A systematic review and meta-analysis","volume":"111","author":"Kundu","year":"2025","journal-title":"Heart"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/s41572-022-00336-y","article-title":"Cancer-associated venous thromboembolism","volume":"8","author":"Khorana","year":"2022","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Alkhalfan, F., Bukhari, S., Rosenzveig, A., Moudgal, R., Khan, S.Z., Ghoweba, M., Chaudhury, P., Cameron, S.J., and Tefera, L. (2024). The Obesity Mortality Paradox in Patients with Pulmonary Embolism: Insights from a Tertiary Care Center. J. Clin. Med., 13.","DOI":"10.3390\/jcm13082375"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1007\/s00277-025-06197-1","article-title":"The outcomes of the obesity paradox in pulmonary embolism: A study of the national inpatient sample database from 2016 to 2020","volume":"104","author":"Garg","year":"2025","journal-title":"Ann. Hematol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.1016\/j.jacc.2025.09.1504","article-title":"Obesity and Acute Pulmonary Embolism: Clinical Implications and Knowledge Gaps","volume":"86","author":"Zuin","year":"2025","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1055\/s-0042-1749659","article-title":"Post-Pulmonary Embolism Syndrome and Functional Outcomes after Acute Pulmonary Embolism","volume":"49","author":"Luijten","year":"2023","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e12451","DOI":"10.1002\/pul2.12451","article-title":"Cardiopulmonary exercise testing following acute pulmonary embolism: Systematic review and pooled analysis of global studies","volume":"14","author":"VanAken","year":"2024","journal-title":"Pulm. Circ."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"240241","DOI":"10.1183\/16000617.0241-2024","article-title":"Exercise and pulmonary embolism: A systematic review of exercise safety, feasibility and effectiveness","volume":"34","author":"Xiang","year":"2025","journal-title":"Eur. Respir. Rev."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC Guidelines on cardiovascular disease prevention in clinical practice","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e097304","DOI":"10.1136\/bmjopen-2024-097304","article-title":"Knowledge, attitudes and practices regarding deep vein thrombosis among patients presenting with lower limb swelling and pain and their families: A cross-sectional survey at a tertiary hospital in China","volume":"15","author":"Zhang","year":"2025","journal-title":"BMJ Open"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"4019","DOI":"10.1093\/eurheartj\/ehae466","article-title":"European Society of Cardiology: The 2023 Atlas of Cardiovascular Disease Statistics","volume":"45","author":"Timmis","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1097\/HJH.0000000000003461","article-title":"Ups and downs of conducting a national representative survey on hypertension during pandemic time: Main results of SEPHAR IV","volume":"41","author":"Dorobantu","year":"2023","journal-title":"J. Hypertens."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Pan\u0103, A., Strilciuc, \u0218., and Ileanu, B.V. (2025). Dietary Disruptors in Romania: Seasonality, Traditions, and the COVID-19 Pandemic. Nutrients, 17.","DOI":"10.3390\/nu17010183"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1159\/000525240","article-title":"Controlling Nutritional Status Score Predicts In-Hospital Mortality in Acute Pulmonary Embolism","volume":"31","author":"Karakaya","year":"2022","journal-title":"Med. Princ. Pract."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e2895","DOI":"10.1097\/MD.0000000000002895","article-title":"Interaction Between Dietary Vitamin K Intake and Anticoagulation by Vitamin K Antagonists: Is It Really True? A Systematic Review","volume":"95","author":"Violi","year":"2016","journal-title":"Medicine"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e259467","DOI":"10.1001\/jamanetworkopen.2025.9467","article-title":"Low-Density Lipoprotein Cholesterol Levels and Bleeding Risk in Venous Thromboembolism","volume":"8","author":"Siniscalchi","year":"2025","journal-title":"JAMA Netw. Open"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1678","DOI":"10.1001\/archinte.168.15.1678","article-title":"Overweight, Obesity, and the Risk of Recurrent Venous Thromboembolism","volume":"168","author":"Eichinger","year":"2008","journal-title":"Arch. Intern. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1249\/01.MSS.0000078924.61453.FB","article-title":"International Physical Activity Questionnaire: 12-country reliability and validity","volume":"35","author":"Craig","year":"2003","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Lee, P.H., Macfarlane, D.J., Lam, T.H., and Stewart, S.M. (2011). Validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF): A systematic review. Int. J. Behav. Nutr. Phys. Act., 8.","DOI":"10.1186\/1479-5868-8-115"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"107087","DOI":"10.1016\/j.rmed.2022.107087","article-title":"Test-retest reliability, agreement and construct validity of the International Physical Activity Questionnaire short-form (IPAQ-sf) in people with COPD","volume":"206","author":"Flora","year":"2023","journal-title":"Respir. Med."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Balboa-Castillo, T., Mu\u00f1oz, S., Ser\u00f3n, P., Andrade-Mayorga, O., Lavados-Romo, P., and Aguilar-Farias, N. (2023). Validity and reliability of the international physical activity questionnaire short form in Chilean adults. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0291604"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.3945\/jn.110.135566","article-title":"A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women","volume":"141","author":"Estruch","year":"2011","journal-title":"J. Nutr."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Garc\u00eda-Conesa, M.T., Philippou, E., Pafilas, C., Massaro, M., Quarta, S., Andrade, V., Jorge, R., Chervenkov, M., Ivanova, T., and Dimitrova, D. (2020). Exploring the Validity of the 14-Item Mediterranean Diet Adherence Screener (MEDAS): A Cross-National Study in Seven European Countries around the Mediterranean Region. Nutrients, 12.","DOI":"10.3390\/nu12102960"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.clnesp.2022.12.026","article-title":"Validation of the 14-item Mediterranean diet adherence screener","volume":"53","author":"Bekar","year":"2023","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1111\/j.1360-0443.1991.tb01879.x","article-title":"The Fagerstr\u00f6m Test for Nicotine Dependence: A revision of the Fagerstr\u00f6m Tolerance Questionnaire","volume":"86","author":"Heatherton","year":"1991","journal-title":"Br. J. Addict."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"207","DOI":"10.4103\/ipj.ipj_51_21","article-title":"Psychometric properties of Fagerstrom Test of Nicotine Dependence: A systematic review","volume":"30","author":"Sharma","year":"2021","journal-title":"Ind. Psychiatry J."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"3186","DOI":"10.1097\/00007632-200012150-00014","article-title":"Guidelines for the process of cross-cultural adaptation of self-report measures","volume":"25","author":"Beaton","year":"2000","journal-title":"Spine"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/j.jclinepi.2010.02.006","article-title":"The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes","volume":"63","author":"Mokkink","year":"2010","journal-title":"J. Clin. Epidemiol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.jclinepi.2006.03.012","article-title":"Quality criteria were proposed for measurement properties of health status questionnaires","volume":"60","author":"Terwee","year":"2007","journal-title":"J. Clin. Epidemiol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1007\/s11136-018-1829-0","article-title":"COSMIN methodology for evaluating the content validity of patient-reported outcome measures: A Delphi study","volume":"27","author":"Terwee","year":"2018","journal-title":"Qual. Life Res."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1007\/s11136-021-02822-4","article-title":"COSMIN reporting guideline for studies on measurement properties of patient-reported outcome measures","volume":"30","author":"Gagnier","year":"2021","journal-title":"Qual. Life Res."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.1007\/s11136-025-03950-x","article-title":"COSMIN reporting guideline for studies on measurement properties of patient-reported outcome measures: Version 2.0","volume":"34","author":"Gagnier","year":"2025","journal-title":"Qual. Life Res."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"m441","DOI":"10.1136\/bmj.m441","article-title":"Calculating the sample size required for developing a clinical prediction model","volume":"368","author":"Riley","year":"2020","journal-title":"BMJ"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1002\/nur.20147","article-title":"The content validity index: Are you sure you know what\u2019s being reported? Critique and recommendations","volume":"29","author":"Polit","year":"2006","journal-title":"Res. Nurs. Health"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1002\/(SICI)1097-0258(19980115)17:1<101::AID-SIM727>3.0.CO;2-E","article-title":"Sample size and optimal designs for reliability studies","volume":"17","author":"Walter","year":"1998","journal-title":"Stat. Med."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"f2492","DOI":"10.1136\/bmj.f2492","article-title":"Diagnostic Accuracy of Conventional or Age Adjusted D-Dimer Cut-Off Values in Older Patients with Suspected Venous Thromboembolism: Systematic Review and Meta-Analysis","volume":"346","author":"Schouten","year":"2013","journal-title":"BMJ"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1001\/jama.2025.21561","article-title":"Age-Adjusted D-Dimer Cutoff Levels to Rule Out Deep Vein Thrombosis: The ADJUST-DVT Study","volume":"335","author":"Thiruganasambandamoorthy","year":"2026","journal-title":"JAMA"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1817","DOI":"10.1001\/jama.2026.2842","article-title":"Age-Adjusted D-Dimer Cutoffs to Exclude DVT [Letter]","volume":"335","author":"Siniscalchi","year":"2026","journal-title":"JAMA"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1056\/NEJMoa2102953","article-title":"New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race","volume":"385","author":"Inker","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1161\/CIRCULATIONAHA.109.192644","article-title":"Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity","volume":"120","author":"Alberti","year":"2009","journal-title":"Circulation"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1111\/j.1538-7836.2005.01204.x","article-title":"Definition of Major Bleeding in Clinical Investigations of Antihemostatic Medicinal Products in Non-Surgical Patients","volume":"3","author":"Schulman","year":"2005","journal-title":"J. Thromb. Haemost."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1177\/1403494818761971","article-title":"A comparison of measured versus self-reported anthropometrics for assessing obesity in adults: A literature review","volume":"46","author":"Maukonen","year":"2018","journal-title":"Scand. J. Public Health"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1194\/jlr.R300019-JLR200","article-title":"Effects of infection and inflammation on lipid and lipoprotein metabolism: Mechanisms and consequences to the host","volume":"45","author":"Khovidhunkit","year":"2004","journal-title":"J. Lipid Res."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1016\/S0895-4356(01)00341-9","article-title":"Internal validation of predictive models: Efficiency of some procedures for logistic regression analysis","volume":"54","author":"Steyerberg","year":"2001","journal-title":"J. Clin. Epidemiol."},{"key":"ref_84","first-page":"1322","article-title":"Missing Data in Clinical Research: A Tutorial on Multiple Imputation","volume":"37","author":"Austin","year":"2021","journal-title":"Can. J. Cardiol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","article-title":"A guideline of selecting and reporting intraclass correlation coefficients for reliability research","volume":"15","author":"Koo","year":"2016","journal-title":"J. Chiropr. Med."},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Gerke, O. (2020). Reporting Standards for a Bland\u2013Altman Agreement Analysis: A Review of Methodological Reviews. Diagnostics, 10.","DOI":"10.3390\/diagnostics10050334"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7573\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T01:53:58Z","timestamp":1791597238000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7573"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":86,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197573"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197573","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]}}}