title: Simplified PESI score and sex difference in prognosis of acute pulmonary embolism: a brief report from a real life study.
abstract: Prognostic stratification of acute pulmonary embolism (PE) remains a challenge in clinical practice. Simplified PESI (sPESI) score is a practical validated score aimed to stratify 30-day mortality risk in acute PE. Whether prognostic value of sPESI score differs according to sex has not been previously investigated. Therefore the aim of our study was to provide information about it. Data records of 452 patients, 180 males (39.8 %) and 272 females (60.2 %) discharged for acute PE from Internal Medicine wards of Tuscany (Italy) were analysed. sPESI was retrospectively calculated. Variables enclosed in sPESI score, all cause in-hospital mortality and overall bleedings were compared between sexes. Moreover, predictive ability of sPESI score as prognosticator of all cause in-hospital mortality was tested and compared between sexes. sPESI score 0 (low risk) was found in 17.7 % of males and 13.6 % of females (p = 0.2323). We didn't find significant difference in sPESI scoring distribution. Age ≥80 years (51.4 vs. 33.8 %, p = 0.0003) and heart rate ≥110 bpm (23.5 vs. 14.4 %, p = 0.0219) were found significantly more prevalent in females, whereas active cancer (23.8 vs. 39.4 %, p = 0.0004) and cardio-respiratory diseases (19.8 vs. 27.7 %, p = 0.0416) were in males. All cause in-hospital mortality was 0 % in both genders for sPESI score 0, whereas it was 5.4 % in females and 13.6 % in males with sPESI score 1-2 (p = 0.0208) and 22 % in females and 19.3 % in males with sPESI score ≥3 (p = 0.7776). Overall bleedings were significantly more frequent in females compared with males (4.77 vs. 0.55 %, p = 0.0189). In females overall bleedings ranged from 2.7 % in sPESI score 0 to 6 % in sPESI score ≥3. Predictive ability of sPESI score as prognosticator of all cause in-hospital mortality was higher in females compared to males (AUC 0.72 vs. 0.67, respectively). In real life different co-morbidity burdens in females compared to males. Females seems to be at lower risk of all cause in-hospital mortality for sPESI score ≤2 but at higher risk of bleeding, irrespective from sPESI scoring. Predictive ability of sPESI score seems better in females.
authors.affiliation: Medicina Interna, Ospedale Santa Maria Nuova, Florence, Italy. luca.masotti@tin.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Masotti
authors.affiliation: Medicina Interna, Ospedale di Pescia, Pescia, Italy.
authors.forename: Grazia
authors.initials: G
authors.lastname: Panigada
authors.affiliation: Medicina Interna, Ospedale Santa Maria Nuova, Florence, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Landini
authors.affiliation: Medicina Interna, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Pieralli
authors.affiliation: Medicina Interna, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Corradi
authors.affiliation: Medicina Interna, Ospedale San Donato, Arezzo, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Lenti
authors.affiliation: Medicina Interna, Ospedale di Cortona, Cortona, Italy.
authors.forename: Rino
authors.initials: R
authors.lastname: Migliacci
authors.affiliation: Medicina Interna, Ospedale San Donato, Arezzo, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Arrigucci
authors.affiliation: Medicina Interna, Ospedale di Borgo San Lorenzo, Florence, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Frullini
authors.affiliation: Medicina Interna, Ospedale di Barga, Lucca, Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Bertieri
authors.affiliation: Medicina Interna, Ospedale Santa Maria Annunziata, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tatini
authors.affiliation: Medicina Interna, Ospedale San Giovanni di Dio, Florence, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Fortini
authors.affiliation: Medicina Interna, Ospedale di Grosseto, Grosseto, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Cascinelli
authors.affiliation: Medicina Interna, Ospedale di Livorno, Livorno, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Mumoli
authors.affiliation: Medicina Interna, Ospedale di Livorno, Livorno, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Giuntoli
authors.affiliation: Medicina Interna, Ospedale di Massa Marittima, Massa Marittima, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: De Palma
authors.affiliation: Medicina Interna, Ospedale di Orbetello Grosseto, Orbetello, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: De Crescenzo
authors.affiliation: Medicina Interna, Ospedale di Piombino, Piombino, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Piacentini
authors.affiliation: Medicina Interna, Ospedale Cisanello Pisa, Pisa, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Tintori
authors.affiliation: Medicina Interna, Ospedale di Campostaggia Siena, Campostaggia, Italy.
authors.forename: Alba
authors.initials: A
authors.lastname: Dainelli
authors.affiliation: Medicina Interna, Ospedale di Pontedera, Pontedera, Italy.
authors.forename: Giuseppa
authors.initials: G
authors.lastname: Levantino
authors.affiliation: Medicina Interna, Ospedale di Portoferraio Livorno, Portoferraio, Italy.
authors.forename: Plinio
authors.initials: P
authors.lastname: Fabiani
authors.affiliation: Medicina Interna, Ospedale di Prato, Prato, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Risaliti
authors.affiliation: Medicina Interna, Ospedale di San Sepolcro Arezzo, Sansepolcro, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Mastriforti
authors.affiliation: Medicina Interna, Ospedale Le Scotte Siena, Siena, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Voglino
authors.affiliation: Medicina Interna, Ospedale di Viareggio, Camaiore, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Carli
authors.affiliation: Medicina Interna, Ospedale Santa Maria Annunziata, Florence, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Meini
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006331:Heart Diseases / Q000401:mortality; D006470:Hemorrhage / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D015995:Prevalence; D011655:Pulmonary Embolism / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012727:Sex Characteristics; D015996:Survival Rate
keywords: Acute pulmonary embolism; Female sex; Gender; PESI; Prognosis