| Background:There is a limited literature on the survival rates of male and female patients in surviving pulmonary embolism(PE)in Intensive Care Units(ICU).With severe cases of PE,interventions have been found to be crucial,although the results of PE demanding mechanical ventilation(MV)support are still controversial.As such,this calls for study of its disparities.Our study aimed to compare features of gender inequalities and outcomes following pulmonary embolism treatment as the reason for their admission in the ICU.Materials and methods:A multicenter retrospective cohort study was conducted between January 2013 and December 2020.We first analyzed gender discrepancies,then we compared the major outcomes survivors versus non-survivors,before further categorizing the outcomes between ventilated and non-ventilated groups.Additionally,we only included adult patients with PE who were aged 18 years and diagnosed by computed tomography pulmonary angiography,excluding patients whose diagnoses were made using other diagnostic methods or who were contraindicated for CTPA testing.All data were retrieved from hospital databases and patient medical records of pulmonary embolism patients admitted to the intensive care unit(ICU)from six hospitals in Shandong province in China.First results:The study included 100 confirmed PE patients,mean age of 62±14 years.Of them 55 females,with co-morbidity chronic heart disease(20%vs 4.4%),cigarette smokers(9.1%vs 51.1%)all had(p<0.05)as compared to males.Additionally,females scored higher on APACHEⅡ(17.12 vs 15.10,(p>0.05),and more deaths occurred at 30-day and 6-month intervals(4.7%and 6.1%)respectively,although these differences were not statistically significant(p>0.05).Second results:Interestingly,the group of non-survivors,as expected,displayed significant physiological abnormalities(pH,heart rate,and HCO3-),APACHE Ⅱ score,as well as cardiac troponin Ⅰ(p<0.05 for all).Similarly,prevalence of chronic illnesses such as heart disease and cancer,as well as complications respiratory failure,kidney injury,liver injury and infection all had(p<0.05)negatively affected prognosis and outcomes.As the result anticoagulants therapy applied some of non-survivors developed subarachnoid hemorrhage(SAH)and thrombocytopenia which all showed(p<0.05).In case of therapy used vasopressors had(p<0.05)despite 9(56%)of patients received dead.Likewise,Mechanical ventilation(MV),Extra-corporeal membrane oxygenation(ECMO),and embolectomy all had(p<0.05)between the two groups,but death rate in patients received MV,ECMO,and embolectomy were 11(69%),3(19%),and 2(13%)respectively.In addition,given that 16(16%)people received cardio-pulmonary resuscitation(CPR),only 7(44%)died.Both CPR measures and mortality rates were statistically significant all had(p<0.05)and patients who died at 30-days and 6-months were found to be 6%and 10%consecutively,showed(p<0.05).Finally,sub-gender group division based on survivors and nonsurvivors demonstrated that kidney injury was common in both sexes and that there was a statistically significant difference between females and males(p<0.05).Additionally,in the population of survivors,male smokers represented a statistically significant(p<0.05),with 51%higher proportion than female smokers.In non-survivor patients,females had greater blood pressure dysregulation than males showed(p<0.05).Third results:For ventilated patients,comorbidities were common cancer and diabetes,as well as sequelae such CPR,acute renal injury,pneumonia,and infection(p<0.05).In addition,abnormal vital signs such as heart rate,diastolic pressure,pH,HCO3-,PaO2,lactate level,and a high APACHE Ⅱ score(allp<0.05)suggested severity and a poor prognosis.All ventilated patients had almost two times longer duration of hospitalization as compared to non-intubated patients,the average time of hospital stay and ICU stay were 18 days and 9 days,respectively(p<0.05 for both).Also,the overall mortality for patients kept on MV were(14%vs 2%)at 30 days(p<0.05)and(16%vs 6%)at 6 months(p>0.05).Fourth results:Factors attributed to mortality in descending order,were as follows;CPR(OR6.48,p=0.001)95%CI,acute liver injury(OR6.23,p=0.02)95%CI,vasopressors(OR5.46,p=0.001)95%CI,Acute kidney injury(OR5.27,p=0.02)95%CI,MV(OR4.90,p=0.02)95%CI,respiratory failure(OR4.00,p=0.02)95%CI,APACHE Ⅱ score(OR1.07,p=0.03)95%CI,Infections(OR5.86,p=0.06)95%CI,ECMO(OR0.16,p=0.04)95%CI.Conclusion:Our study revealed no statistically significant sex-based differences in outcomes,with the exception of chronic heart disease,which has been proven to have a negative impact.PE-related complications and comorbidities have been identified as statistically significant contributors to poor prognosis and mortality.Furthermore,the necessity for MV has negative prognostic factors,contributing to an increased 30-day death rate and longer hospital stays. |
PDF Full Text Request