Sex disparities of clinical manifestations in acute pulmonary embolism and predictive value for in-hospital mortality: Insights from CURES
Han Tian a) b), Yu Zhang b) c), JiXiang Liu b), Yuanhua Yang d), Yingqun Ji e), Hong Chen f), Dingyi Wang b) g), Zhu Zhang b), Qun Yi h), Chunling Dong i), Xiaomao Xu j), Xiaoyun Hu k), Yimin Mao l), Ling Zhu m), Zhihong Liu n), Juhong Shi o), Chaosheng Deng p), Zhe Cheng q), Yunxia Zhang b), Meng Zhang r), Wenyi Pang s), Jieping Lei b) g), Sinan Wu b) g), Yuzhi Tao t), Linfeng Xi b) c), Qian Gao b), Shuai Zhang b), Chaozeng Si u), Lei Xia v), Min Liu w), Aili Li x), Yihong Sun x), Qiang Huang b), Wanmu Xie b), Jun Wan r), Peiran Yang y), Shengfeng Wang z), Chen Wang a) b), Zhenguo Zhai a) b) on behalf of the
CURES investigators
a) China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
b) National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
c) China-Japan Friendship Hospital, Capital Medical University, Beijing, China
d) Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
e) Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Shanghai, China
f) Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
g) Data and Project Management Unit, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
h) Sichuan Cancer Hospital, Chengdu, China
i) Department of Pulmonary and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China
j) Department of Pulmonary and Critical Care Medicine, Beijing Hospital, Beijing, China
k) Department of Pulmonary and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, China
l) Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
m) Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
n) Fuwai Hospital, Chinese Academy of Medical Science, National Center for Cardiovascular Diseases, Beijing, China
o) Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China
p) Department of Pulmonary and Critical Care Medicine, The first affiliated Hospital of Fujian Medical University, Fuzhou, China
q) Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
r) Department of Pulmonary and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
s) Department of Pulmonary and Critical Care Medicine, Beijing Jishuitan Hospital, Fourth Medical College of Peking University, Beijing, China
t) The First Bethune Hospital of Jilin University, Changchun, China
u) Department of Information Management, China-Japan Friendship Hospital, Beijing, China
v) Medical Affairs Department of China-Japan Friendship Hospital, Beijing, China
w) Department of Radiology, China-Japan Friendship Hospital, Beijing, China
x) Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
y) State Key Laboratory of Respiratory Health and Multimorbidity, Department of Physiology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China
z) Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
Abstract
Background
Pulmonary embolism (PE) is a common and potentially fatal disease, with differences in mortality rates among PE patients of different sexes. This study aims to investigate the disparities in clinical manifestations and in-hospital mortality rates between sexes in PE patients, as well as the association of clinical symptoms with in-hospital mortality.
Methods
We analyzed data from the China pUlmonary thromboembolism REgistry Study (CURES), a nationwide, multicenter, prospective registry focusing on patients with acute PE. Using propensity score matching (PSM) to pair male and female patients with PE, we explored the correlation between clinical symptoms and in-hospital mortality through multivariable regression analysis.
Results
A total of 15,203 patients with acute PE were enrolled, and 380 died during hospitalization. The incidence of chest pain, hemoptysis, and palpitations was significantly higher in males compared to females. The incidence of dyspnea, fever, and syncope was higher in females. Hemoptysis and dyspnea were associated with increased in-hospital mortality in males, whereas dyspnea, fever, and palpitations were linked to higher mortality in females. Overall, males exhibited a higher in-hospital mortality than females (2.9 % vs. 2.1 %, p = 0.002). After matching 13,130 patients using the PSM method, the mortality rate of males remained higher than that of females (2.7 % vs. 2.1 %, p = 0.020).
Conclusions
Our study demonstrates that male patients with PE have a higher risk of in-hospital mortality than females. Significant differences in clinical symptoms between sexes are associated with increased mortality risk, emphasizing the need for clinical awareness.