Sex Differences as Predictors of In-Hospital Outcome in Patients with Acute Pulmonary Embolism

Background: Sex-related differences in cardiovascular disease outcomes are well recognized. Their impact on short-term outcomes in acute pulmonary embolism (PE) remains unclear. This study aimed to assess the association between sex and in-hospital outcomes in patients with acute PE. Methods: We performed a retrospective observational cohort study including 322 consecutive adult patients with acute PE admitted to a university hospital. Clinical, hemodynamic, laboratory, and imaging data were collected at presentation. The primary outcome was a composite poor outcome defined as intensive care unit (ICU) admission, systemic thrombolysis, or in-hospital mortality. Multivariable logistic regression analysis was used to evaluate whether sex independently predicted adverse outcomes after adjustment for established prognostic factors. Results: This study included 322 patients with acute pulmonary embolism (mean age 64.4 ± 13.1 years), of whom 50.0% were women. The composite poor outcome occurred more frequently in women than in men (34.0% vs. 22.7%, p = 0.032). Female sex was associated with increased odds of poor outcome in univariate analysis (odds ratio (OR) 1.76; 95% confidence interval (CI) 1.08-2.88). This association remained significant after multivariable adjustment (adjusted OR 1.69; 95% CI 1.02-2.82; p = 0.042). No significant sex differences were observed for individual components of the composite endpoint. Conclusions: Female sex was independently associated with a higher risk of adverse in-hospital outcomes in acute PE, suggesting that sex-specific factors may influence early prognosis and should be considered in future risk stratification models.