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.

Crucial considerations: Sex differences in the epidemiology, diagnosis, treatment, and outcomes of acute pulmonary embolism in non‐pregnant adult patients

“…94,95 Although sex is not a factor in the sPESI, several studies have suggested that it may predict adverse outcomes more accurately in women than men despite that it performs well in both sexes. 57,96 In addition, using sex-specific biomarker cutoff values was shown to improve the performance and predictive value of the 2014 ESC guidelines, though this finding has not been replicated. 57 Future investigations should focus on sex-specific prognostic factors in acute PE.…”

A New Index for the Prediction of 30-Day Mortality in Patients With Pulmonary Embolism: The Pulmonary Embolism Mortality Score (PEMS)

“…27 The predictive ability of the sPESI score as prognosticator of all cause in-hospital mortality was higher in females compared with males. 27 Our data did not confirm these results; age and gender did not influence the 30-day mortality in the present study. According to the literature, some clinical signs such as syncope can also be used as predictor of PE outcome.…”

“… 26 Finally, a different predictive accuracy of the sPESI among gender was reported. 27 The predictive ability of the sPESI score as prognosticator of all cause in-hospital mortality was higher in females compared with males. 27 Our data did not confirm these results; age and gender did not influence the 30-day mortality in the present study.…”

Pulmonary Embolism in Women: A Systematic Review of the Current Literature

“…Despite the differences in incidence and clinical features, analysis of 371 patients from the EINSTEIN-PE study, which evaluated the use of rivaroxaban for the management of symptomatic PE, showed no sex-based differences in clot resolution at 3 weeks after treatment [ 65 ]. Menendez et al conducted a retrospective follow-up study of 102 patients with PE who underwent serial perfusion scans at the time of diagnosis, at 7–10 days, and at 6 months [ 66 ]. Interestingly, the investigators found sex to be an independent predictor of clot size at 7–10 days.…”

“…Of note, for African-American and Hispanic women, the rate of recurrent PE was found to be higher as compared to their Caucasian counterparts ( p < 0.02) [ 70 ]. Multiple studies have found significantly higher rates of major bleeding in women as compared to men [ 15 , 22 , 66 ]. Keller et al also found that major bleeding was a significant predictor of all-cause mortality in women [ 22 ].…”