Key result
Diabetes mellitus was associated with increased all-cause mortality in women with acute pulmonary embolism (HR 2.31; 95% CI 1.45-3.65), but not in men (HR 1.10; 95% CI 0.59-2.04; interaction p=0.04).
Why the study?
Diabetes mellitus predicts ominous outcomes in acute pulmonary embolism, but the influence of gender on this prognostic impact is unknown.
Does diabetes mellitus increase all-cause mortality in patients with acute pulmonary embolism, and is this effect influenced by gender?
Cohort (n=577)
Does diabetes mellitus increase all-cause mortality in patients with acute pulmonary embolism, and is this effect influenced by gender?
Hazard Ratio: 2.33 (95% CI 1.51–3.61)
Diabetes mellitus is associated with a twofold increase in long-term mortality risk in women with acute pulmonary embolism, but not in men.
May support sex-specific risk stratification in diabetic PE; leaves open confirmation and management implications.
Diabetes mellitus (DM) predicts ominous outcomes in acute pulmonary embolism (PE). The influence of gender on the prognostic impact of DM in PE is unknown. We did a retrospective analysis of a cohort of patients hospitalized with PE between 2006 and 2013. The exclusion criteria were age <18, non-pulmonary veins thromboembolism, recurrent PE, chronic thromboembolic pulmonary hypertension, no radiologic confirmation of PE, and active neoplasia. The primary endpoint was all-cause mortality. The follow-up was from diagnosis until October 2017. We assessed the prognostic impact of DM using a multivariate Cox regression analysis. The analysis was stratified according to gender. The interaction between gender and DM in the outcome of patients with PE was tested. We studied 577 PE patients (median age 65 years, 36.9% men, 19.8% diabetic). The genders were similar regarding the prevalence of DM, the extension and location of PE, and the thrombolytic therapy or brain natriuretic peptide (BNP) value. Diabetics presented higher all-cause mortality (Hazard ratio (HR) = 2.33 (95% confidence Interval (CI) 1.513.61)) when compared with non-diabetics. However, when analysis was stratified according to gender, DM was independently associated with a worse prognosis only in women (HR = 2.31 (95% CI 1.453.65)), while in men the HR was 1.10 (95% CI 0.592.04). The interaction between gender and DM was significant (p = 0.04). Gender influences the prognostic impact of DM in acute PE. Diabetic women with PE have twice the long-term mortality risk, while DM is not mortality-associated in men.
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Oliveira et al. (2020) conducted a cohort in acute pulmonary embolism (n=577). Diabetes mellitus vs. Non-diabetics was evaluated on all-cause mortality (HR 2.33, 95% CI 1.51-3.61). Diabetes mellitus was associated with increased all-cause mortality in women with acute pulmonary embolism (HR 2.31; 95% CI 1.45-3.65), but not in men (HR 1.10; 95% CI 0.59-2.04; interaction p=0.04).
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