Among African American patients with sickle cell disease and acute pulmonary embolism, females had higher odds of receiving transfusions than males, with no significant differences in mortality.
Observational (n=3,635)
Yes
Does female sex affect in-hospital outcomes in African American patients with sickle cell disease admitted for acute pulmonary embolism?
Sex-based differences in outcomes among African American patients with sickle cell disease admitted for acute pulmonary embolism are limited, though females have significantly higher transfusion requirements.
Abstract Introduction Sickle cell disease (SCD) disproportionately affects African Americans (AA), comprising over 90% of cases. Acute pulmonary embolism (APE) is a serious complication in SCD patients due to increased thromboembolic risk from chronic inflammation, endothelial dysfunction, and hypercoagulability. Although recent studies have demonstrated sex-based differences in APE outcomes, data remain limited for SCD patients. We evaluated sex-based differences in outcomes among AA SCD patients with APE. Methods AA adults with SCD hospitalized for APE were queried from the 2016-2022 National Inpatient Sample. COVID-19 positive patients, patients younger than 18 years, and cases missing data were excluded. Demographics, treatment patterns, and in-hospital outcomes were compared between males and females using appropriate statistical tests with survey-weighted analysis. Results We studied 3635 SCD patients who were treated for APE, consisting of 60. 66% (3635) females and 39. 34% (2205) males. The overall mean age was 38. 40 years, with no differences between the two sexes (mean age of 38. 71 in males and 38. 20 years in females, p = 0. 620). While males reported a higher comorbidity burden with a Charlson Comorbidity Index (CCI) score of 1. 03 (vs. 0. 92 in females), it was not statistically significant (p = 0. 345). In total, 23. 43% of males and 22. 68% of females had a prior history of PE (p = 0. 815). Medicare constituted 31. 82% of primary payers among males and 38. 36% among females, while Medicaid and private insurance accounted for 32. 52% and 24. 83% of males, and 32. 19% and 25. 11% of females, respectively (p = 0. 015). After adjusting for confounders, we found that females demonstrated higher odds of receiving transfusion to males. No statistically significant differences were seen for mortality, major cardiovascular complications including cardiac arrest, acute kidney injury, acute liver injury, ventricular tachycardia, or cardiogenic shock. In addition, treatment modalities such as mechanical ventilation, vasopressors or thrombolytic interventions (systemic thrombolysis, catheter-directed thrombolysis, mechanical thrombectomy) were comparable between males and females. We further did not find any differences in sepsis, bleeding events, acute ischemic stroke, or acute myocardial infarction (Table 1). Similarly, although females stayed longer (mean: 5. 46 days vs. 4. 90 days, p = 0. 121), and had higher inflation-adjusted charges (61106 vs. 58810, p = 0. 688), they were comparable. Conclusion Our study revealed that sex-based differences in outcome disparities among AA SCD patients admitted for APE are limited, with female transfusion requirements differing significantly, which warrants further investigation. This abstract is funded by: None
Singh et al. (Fri,) conducted a observational in Acute pulmonary embolism in African American patients with sickle cell disease (n=3,635). Female sex vs. Male sex was evaluated on In-hospital mortality. Among African American patients with sickle cell disease and acute pulmonary embolism, females had higher odds of receiving transfusions than males, with no significant differences in mortality.
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