title: Thromboembolic burden, prognostic assessment and outcomes of females compared to males in acute pulmonary embolism.
abstract: BACKGROUND
  Literature lacks on sex differences in acute pulmonary embolism (PE). Therefore, the aim of our study was to provide information about sex difference in thromboembolic burden, prognostic assessment and outcomes of PE.
  
  
  METHODS
  We analyzed and compared differences between females and males retrieving data of a multicenter, observational, retrospective, cohort study aimed to analyze characteristics of PE patients admitted in Internal Medicine wards of Tuscany, Italy.
  
  
  RESULTS
  272 (60.1%) of 452 patients enrolled in the study were females. Females were older than males (76.6 ± 12.0 vs. 73.5 ± 13.4 years, p = 0.0005). Mean length of hospital stay was longer in females (11.3 vs. 9.5 days, p = 0053). Reduced mobility was more frequent in females (46.3% vs. 35.5%, p = 0.0322), whereas COPD and active cancer were in males (20% vs. 9.9%, p = 0.0034, and 39.4% vs. 23.8%, p = 0.0004, respectively). Incidental diagnosis of PE was performed more often in males compared to females (19.3% vs. 11.4%, p = 0.0289). No sex difference was found in diagnostic approach, despite females underwent more often to legs ultrasonography compared to males (90.7% vs. 79.4%, p = 0.0008). Both all cause and PE-related mortality were higher in males (12.2 and 8.3% vs. 7.7 and 5.1%, respectively), despite difference was not significant. Females were found to have more likely central PE and distal deep vein thrombosis compared to males (57.7% vs. 43.8%, p = 0.0039, and 22.9% vs. 13.9%, p = 0.0206, respectively). None difference was found in shock index and median simplified PESI score between females and males, whereas according to 2008 ESC prognostic model females were more likely to be categorized at high or intermediate risk than in males (81.5% vs. 71.5%, p = 0.0159). Echocardiographic right heart dysfunction was found more often in females than in males (56.5% vs. 44%, p = 0.0124). No sex difference was found neither on acute treatment nor in prescription of vitamin K antagonists at hospital discharge. Bleeding events were significantly higher in females compared to males (4.7% vs. 0.5%, p = 0.0189).
  
  
  CONCLUSIONS
  Understanding the difference between females and males is of utmost importance for physicians who manage acute PE in clinical practice. Females present major pulmonary thromboembolic burden, more frequently right heart dysfunction and treatment-related bleedings but lower in-hospital mortality than males. Our study could implicate that management of acute PE should be tailored according to sex. Prospective studies are warranted to better clarify this topic.
authors.affiliation: a Medicina Interna , Ospedale di Pescia , Pescia , Italy.
authors.forename: Grazia
authors.initials: G
authors.lastname: Panigada
authors.affiliation: b Medicina Interna , Ospedale Santa Maria Nuova , Firenze , Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Masotti
authors.affiliation: c Medicina Interna , Ospedale di Bibbiena , Arezzo , Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Rosi
authors.affiliation: a Medicina Interna , Ospedale di Pescia , Pescia , Italy.
authors.forename: Laila
authors.initials: L
authors.lastname: Teghini
authors.affiliation: b Medicina Interna , Ospedale Santa Maria Nuova , Firenze , Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Cimolato
authors.affiliation: d Medicina Interna , Ospedale di Barga , Lucca , Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Bertieri
authors.affiliation: e Medicina Interna , Ospedale Santa Maria Annunziata , Firenze , Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Angotti
authors.affiliation: f Medicina Interna , Ospedale di Grosseto , Grosseto , Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Romagnoli
authors.affiliation: f Medicina Interna , Ospedale di Grosseto , Grosseto , Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Cascinelli
authors.affiliation: g Medicina Interna , Ospedale di Orbetello , Grosseto , Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: De Crescenzo
authors.affiliation: h Medicina Interna , Ospedale di Campostaggia Siena , Italy.
authors.forename: Alba
authors.initials: A
authors.lastname: Dainelli
authors.affiliation: i Medicina Interna , Ospedale di Pontedera , Pisa , Italy.
authors.forename: Giuseppa
authors.initials: G
authors.lastname: Levantino
authors.affiliation: j Medicina Interna , Ospedale di Portoferraio , Livorno , Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Raimondi
authors.affiliation: k Medicina Interna , Ospedale di San Sepolcro Arezzo , Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Nassi
authors.affiliation: k Medicina Interna , Ospedale di San Sepolcro Arezzo , Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Mastriforti
authors.affiliation: l Medicina Interna , Ospedale di Viareggio , Viareggio , Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Lambelet
authors.affiliation: l Medicina Interna , Ospedale di Viareggio , Viareggio , Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Carli
authors.affiliation: m Medicina Interna , Ospedale di Borgo San Lorenzo , Firenze , Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Frullini
authors.affiliation: n Medicina Interna , Azienda Ospedaliera Universitaria Careggi , Firenze , Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Grazzini
authors.affiliation: n Medicina Interna , Azienda Ospedaliera Universitaria Careggi , Firenze , Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Ciucciarelli
authors.affiliation: n Medicina Interna , Azienda Ospedaliera Universitaria Careggi , Firenze , Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Bucherelli
authors.affiliation: n Medicina Interna , Azienda Ospedaliera Universitaria Careggi , Firenze , Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Petrioli
authors.affiliation: n Medicina Interna , Azienda Ospedaliera Universitaria Careggi , Firenze , Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Casati
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome
keywords: Diagnosis; Female sex; Prognosis; Pulmonary Embolism; Risk factors