Sex-specific and age-related seasonal variations regarding incidence and in-hospital mortality of pulmonary embolism in Germany

Abstract

BackgroundStudies have reported seasonal variations regarding the incidence and the short-term mortality of pulmonary embolism (PE). The aim of this study was to identify sex-specific and age-related differences in seasonal patterns regarding hospitalisations and mortality of PE patients.MethodsWe analysed the impact of seasons on incidence and in-hospital mortality of male and female hospitalised PE patients in Germany (2005–2015) based on the German nationwide inpatient sample.ResultsThe German nationwide inpatient sample comprised 885 806 hospitalisations due to PE (2005–2015). Seasonal variations of both incidence (p=0.021) and in-hospital mortality (p<0.001) were of significant magnitude. Quarterly annual incidence (25.5 versus 23.7 of 100 000 citizens per year, p=0.021) and in-hospital mortality (17.0% versus 16.7%, p=0.008) were higher in winter than in summer. Risk of in-hospital mortality in winter was slightly higher (OR 1.03 (95% CI 1.01–1.06), p=0.015) compared to summer, independently of sex, age and comorbidities. Additionally, we observed sex-specific differences during seasons: the highest number of hospitalisations of PE patients of both sexes was during winter, whereas the nadir of male patients was in spring and that of female patients was in summer. Both sexes showed a maximum of in-hospital mortality in spring. Seasonal variation regarding incidence and mortality was pronounced in older patients.ConclusionIncidence and the in-hospital mortality of PE patients showed a significant seasonal variation with sex-specific differences. Although it has to be hypothesised that the seasonal variation of PE is multifactorially dependent, variation in each season was not explained by seasonal differences regarding age, sex and the prevalence of important comorbidities.

Blood Urea Nitrogen to Serum Albumin Ratio Independently Predicts Mortality in Critically Ill Patients With Acute Pulmonary Embolism

“…Gender and age significantly differed between the nonsurvivors and survivors groups in ICU hospitalization in our study as reported by Keller et al 24 However, the reason for the disparity remains unclear. Nevertheless, older patients are prone to a series of basic diseases.…”

“…Compared with the survivors group, the non-survivors group had significantly higher respiratory rate (21.3 [18.1-24.7] vs 19.7 [17.3-22.3], P < 0 .001), lower SBP (110.1 [101.2-122.3] vs 118.4 [108.3-129.4], P < 0.001) and lower SpO2 (96.7 [94.6-98.3] vs 97.0 [95.7-98.5], P ¼ 0.048). Moreover the nonsurvivors group had significantly higher SAPSII (47 36-60 vs 30,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] P < 0.001), SIRS (3 3-4 vs 3, 2-4 P < 0.001), SOFA (5 3-8 vs 3, 1-5 P ¼ 0.006) and APSIII (54 40-75 vs 36, 28-48 P < 0.001) than the survivors group. Similarly, when compared to the survivors group, the non-survivors group had significantly higher creatinine (1.2 [0.8-2.0] vs 0.8 [0.7 -1.1], P < 0.001), blood urea nitrogen (BUN) (30.8 [19.0-46.5] vs 16.1[11.8-22.8], P < 0.5-11.7], P ¼ 0.004).…”

Optimal management, prevalence, and clinical behavior of saddle pulmonary embolism: A systematic review and meta-analysis

“…SPE-related mortality was observed in 4.6 % of all SPE cases and 8 % following a meta-analysis of the observational studies. Studies on PE in general from Germany, Japan, Italy, and the USA reported mortality rates of 17 %, 14 %, 10 %, and 12 % respectively [34][35][36][37]. In a recent study on acute PE by the authors of this review, a low PE-related mortality rate of 3.4 % was reported [29].…”

Clinical and hemodynamic features of acute pulmonary embolism patients diagnosed in cold weather predicts adverse clinical outcome

“…A growing body of evidence has reported that the onset rate and mortality rate from major cardiovascular diseases is influenced by seasonal variation and APE is of no exception ( 3 – 5 ). Several studies demonstrated a peak incidence and mortality rate of APE during winter season, conflicting results on the influence of weather on disease outcomes have been presented in literature ( 3 , 4 , 6 , 7 ). However, all published studies were epidemiology investigations, and systemic clinical and hemodynamic features of APE were not reported.…”

“…As indicated, there could be a connection between cold weather and morbidity as well as mortality rate of APE, though specific pathophysiological mechanisms are still under investigation ( 8 – 11 ). Several factors may potentially contribute to cold weather effect on the adverse clinical outcome of APE such as abnormal coagulation system, peripheral vasoconstriction, reduced activity, combined cardiovascular disease, et al, which favors prothrombotic changes, cardiac dysfunction and hemodynamic collapse ( 6 , 12 , 13 ). However, previous studies failed to comprehensively investigate the cardiac function and hemodynamic status of APE patients and their values in predicting clinical outcomes.…”