Sex Differences as Predictors of In-Hospital Outcome in Patients with Acute Pulmonary Embolism

TL;DR

This study found that women with acute pulmonary embolism have a higher risk of poor in-hospital outcomes compared to men.

Contribution

The study demonstrates that female sex is an independent predictor of adverse outcomes in acute pulmonary embolism after adjusting for other factors.

Findings

Female patients had a 34.0% composite poor outcome rate compared to 22.7% in males.

Female sex remained a significant predictor of poor outcomes after multivariable adjustment.

No significant sex differences were observed for individual components of the composite endpoint.

Abstract

Background: Sex-related differences in cardiovascular disease outcomes are well recognized. Their impact on short-term outcomes in acute pulmonary embolism (PE) remains unclear. This study aimed to assess the association between sex and in-hospital outcomes in patients with acute PE. Methods: We performed a retrospective observational cohort study including 322 consecutive adult patients with acute PE admitted to a university hospital. Clinical, hemodynamic, laboratory, and imaging data were collected at presentation. The primary outcome was a composite poor outcome defined as intensive care unit (ICU) admission, systemic thrombolysis, or in-hospital mortality. Multivariable logistic regression analysis was used to evaluate whether sex independently predicted adverse outcomes after adjustment for established prognostic factors. Results: This study included 322 patients with acute pulmonary embolism (mean age 64.4 ± 13.1 years), of whom 50.0% were women. The composite poor outcome occurred more frequently in women than in men (34.0% vs. 22.7%, p = 0.032). Female sex was associated with increased odds of poor outcome in univariate analysis (odds ratio (OR) 1.76; 95% confidence interval (CI) 1.08–2.88). This association remained significant after multivariable adjustment (adjusted OR 1.69; 95% CI 1.02–2.82; p = 0.042). No significant sex differences were observed for individual components of the composite endpoint. Conclusions: Female sex was independently associated with a higher risk of adverse in-hospital outcomes in acute PE, suggesting that sex-specific factors may influence early prognosis and should be considered in future risk stratification models.

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