Gülistan KARADENİZ, Enver YALNIZ, Gülru POLAT, Melih BÜYÜKŞİRİN, Aysu AYRANCI, Fatma DEMİRCİ ÜÇSULAR, Damla SERÇE UNAT, Ömer Selim UNAT

Pulmoner Emboli Klinik, Laboratuvar Bulguları, Prognoz ve Mortalite Açısından Cinsiyetler Arasında Farklılık Gösterir mi?

Amaç: Pulmoner Tromboemboli (PTE) mortal ve tanı konulması zor bir hastalıktır. Bulgularınınnonspesifik olması nedeniyle zaman zaman tanıya ulaşmak oldukça zor olmaktadır. Malignite,immobilite, geçirilmiş cerrahi, trombofili, ilerlemiş yaş, genetik faktörler majör risk faktörleridir.PTE’de cinsiyetin prognoz ile ilişkisi hakkında yapılan çalışmalarda oldukça farklı sonuçlar bulunmaktadır. Biz bu çalışmada prognoz, yoğun bakım yatışı, laboratuvar ve radyolojik testler açısından cinsiyet farklılıklarını değerlendirmeyi amaçladık.Yöntem: Ocak 2012 ve Aralık 2015 tarihleri arasında Akut PTE tanılı toplam 348 hastanın verileri retrospektif olarak tarandı. Bu hastaların tümü 3. basamak bir göğüs hastalıkları hastanesiolan merkezimizin acil servisine başvurmuş hastalardı. Prognoz sınıflandırılmaları yapılırkenAvrupa Kardiyoloji Topluluğu (ESC) ve Avrupa Solunum Topluluğu (ERS) tarafından ortak tasarlanan PTE kılavuzu temel alındı.Bulgular: Hastaların yaş ortalaması 62,7 iken erkek hastalar daha genç olarak bulundu. Yaş ortalamasının kadınlarda daha yüksek olmasıyla uyumlu olarak kadınların basitleştirilmiş PulmonerEmboli Ciddiyet Endeksi (sPESI) skoru daha yüksek olarak gözlemlendi. Kadınların kötü prognostik faktörleri daha fazla olmasına rağmen her iki cinsiyet arasında erken mortalite açısındananlamlı bir fark bulunmadı.Sonuç: Yaş ortalamaları ve sPESI skorları arasında fark olmasına rağmen; kadınlarla erkekler arasında erken mortalite farkı bulunmadı. PTE’de cinsiyet çalışması farklı çalışmalarda farklı sonuçlarvermesi ve izlem protokollerini etkileyebilecek olmasından dolayı yeni çalışmalara açık bir alandır.

Does Pulmonary Embolism Differ Between Genders in Terms of Clinical, Laboratory Findings, Prognosis and Mortality?

Objective: Pulmonary thromboembolism (PTE) is a disease that mortal and hardly diagnosed. Since findings of PTE are nonspesific diagnosed can be so hard sometimes. Major risk factors are malignancy, immobility, previous surgery, thrombophilia, advanced age, and genetic factors. Studies on the relationship between gender and prognosis in PTE have very different results. In this study, we aimed to evaluate gender differences in terms of prognosis, intensive care admis- sion, laboratory, and radiological tests. Method: We retrospectively analyzed the data of 348 patients diagnosed with Acute PTE between January 2012 and December 2015. All of these patients were patients who applied to the emergency department of our center, which is a third step chest diseases hospital. We used the PTE guideline jointly designed by the European Society of Cardiology (ESC) and the European Respiratory Society (ERS) for prognosis classifications. Results: The mean age of the patients was 62.7, while the male patients were younger. Women’s sPESI scores and mean ages were observed higher than men. Although women had more bad prognostic factors, no significant difference was found between both genders in terms of early mortality. Conclusion: Although there is a difference between mean age and simplified Pulmonary Embolism Severity Index (sPESI) scores; no difference in early mortality between men and women. Gender studies in PTE are an area that is open to new studies, since the studies conducted on this subject give quite different results and these results may affect the follow-up protocols.

PDF

___

1. Franco RF, Reitsma PH. Genetic risk factors of venous thrombosis. Hum Genet. 2001;109(4):369-84. https://doi.org/10.1007/s004390100593
2. Grippi MA, Elias JA, Fishman JA, Kotloff RM, Pack AI, Senior RM, Siegel MD. Fishman’s Pulmonary Diseases and Disorders [Internet]. Fishman’s Pulmonary Diseases and Disorders, 5e. 2015.
3. Taroeno K. Acute pulmonary embolisms diagnosis and management, Acta Interna - The Journal of Internal Medicine 2007;1:32-6.
4. Tapson VF. Acute pulmonary embolism. N Engl J Med. 2008;358:1037-52. https://doi.org/10.1056/NEJMra072753
5. Francis CW. Prophylaxis for thromboembolism in hospitalized medical patients. N Engl J Med. 2007;356:1438-44. [Erratum, N Engl J Med. 2007;357:203.] https://doi.org/10.1056/NEJMcp067264
6. Oqab Z, Ganshorn H, Sheldon R. Prevalence of pulmonary embolism in patients presenting with syncope. A systematic review and meta-analysis. The American Journal of Emergency Medicine. 2018;36(4):551-5. PMID 28947223. https://doi.org/10.1016/j.ajem.2017.09.015
7. Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data Arch Intern Med, 2003;163:1711-7. https://doi.org/10.1001/archinte.163.14.1711
8. Agarwal S, Clark D, Sud K, Jaber WA, Cho L, Menon V. Gender disparities in outcomes and resource utilization for acute pulmonary embolism hospitalizations in the United States Am J Cardiol, 2015;116:1270-6. https://doi.org/10.1016/j.amjcard.2015.07.048
9. Tanabe Y. Gender differences among patients with acute pulmonary embolism the American Journal of Cardiology Volume 122, Issue 6 15 September 2018, Pages 1079- 1084. https://doi.org/10.1016/j.amjcard.2018.05.042
10. Stavros VG. Meyer ESC. Guidelines for Diagnosis and Treatment of Acute Pulmonary Embolism Developed in Collaboration with the European Respiratory Society (ERS), European Respiratory Journal 2019.
11. Agarwal S, Clark D, Sud K, Jaber WA, Cho L, Menon V. Gender Disparities in Outcomes and Resource Utilization for Acute Pulmonary Embolism Hospitalizations in the United States. Am J Cardiol. 2015;116:1270-6. https://doi.org/10.1016/j.amjcard.2015.07.048
12. Blanco-Molina A, Enea I, Gadelha T, Tufano A, BuraRiviere A, Di Micco P, Bounameaux H, González J, Villalta J, Monreal M; RIETE Investigators. Sex differences in patients receiving anticoagulant therapy for venous thromboembolism. Medicine 2014;93:309-17. https://doi.org/10.1097/MD.0000000000000114
13. Tagalakis V, Kondal D, Ji Y, Boivin JF, Moride Y, Ciampi A, Khan SR. Men had a higher risk of recurrent venous thromboembolism than women: a large population study. Gend Med. 2012;9:33-43. https://doi.org/10.1016/j.genm.2011.12.002
14. Baglin T, Luddington R, Brown K, Baglin C. High risk of recurrent venous thromboembolism in men. J Thromb Haemost. 2004;2:2152-5. https://doi.org/10.1111/j.1538-7836.2004.01050.x
15. McRae S, Tran H, Schulman S, Ginsberg J, Kearon C. Effect of patient’s sex on risk of recurrent venous thromboembolism: a meta-analysis. Lancet. 2006;368:371-8. https://doi.org/10.1016/S0140-6736(06)69110-1
16. Lijfering WM, Veeger NJ, Middeldorp S, Hamulyak K, Prins PH, Büller HR, Meer J. A lower risk of recurrent venous thrombosis in women compared with men is explained by sexspecific risk factors at time of first venous thrombosis in thrombophilic families. Blood. 2009;114:2031-6. https://doi.org/10.1182/blood-2009-04-215418
17. Kyrle PA, Minar E, Bialonczyk C, Hirschl M, Weltermann A, Eichinger S. The risk of recurrent venous thromboembolism in men and women. N Engl J Med. 2004;350:2558- 63. https://doi.org/10.1056/NEJMoa032959
18. Bolaman Z. Demir eksikliği anemisi, 6. İç hastalıkları Kongresi. 19. Carley A. Anemia: When Is it iron deficiency? Pediatr Nurs 2003;29:127-33.
20. Tanabe N, Sugiura T, Tatsumi K. Recent progress in the diagnosis and management of chronic thromboembolic pulmonary hypertension. Respir Investig. 2013;51:134- 46. https://doi.org/10.1016/j.resinv.2013.02.005
21. Keller K, Rappold L, Gerhold-Ay A, Hobohm L, Hasenfuß G, Konstantinides SV, Dellas C, Lankeit M. Sex-specific differences in pulmonary embolism. Thromb Res. 2019 Jun 1;178:173-81. https://doi.org/10.1016/j.thromres.2019.04.020