Oliveira Diana, Brito Teresa, Elias Catarina, Carreira Marta, Serino Mariana, Guerreiro Inês, Magalhães Helena, Coelho Sara, Ferreira Sara, Araújo Emanuel, Ribeiro Ana, Lourenço Patrícia
Serviço de Medicina Interna do Centro Hospitalar e Universitário de São João, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal.
Serviço de Pneumologia do Centro Hospitalar e Universitário de São João, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal.
J Clin Med. 2020 Oct 30;9(11):3511. doi: 10.3390/jcm9113511.
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 ( = 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.
糖尿病（DM）预示着急性肺栓塞（PE）的不良预后。性别对DM在PE预后影响中的作用尚不清楚。我们对2006年至2013年间因PE住院的患者队列进行了回顾性分析。排除标准为年龄<18岁、非肺静脉血栓栓塞、复发性PE、慢性血栓栓塞性肺动脉高压、无PE的放射学确诊以及活动性肿瘤。主要终点是全因死亡率。随访从诊断至2017年10月。我们使用多变量Cox回归分析评估DM的预后影响。分析按性别分层。对PE患者结局中性别与DM之间的相互作用进行了检验。我们研究了577例PE患者（中位年龄65岁，男性占36.9%，糖尿病患者占19.8%）。在DM患病率、PE的范围和部位以及溶栓治疗或脑钠肽（BNP）值方面，两性相似。与非糖尿病患者相比，糖尿病患者的全因死亡率更高（风险比（HR）=2.33（95%置信区间（CI）1.51 - 3.61））。然而，当按性别分层分析时，DM仅在女性中与更差的预后独立相关（HR = 2.31（95%CI 1.45 - 3.65）），而在男性中HR为1.10（95%CI 0.59 - 2.04）。性别与DM之间的相互作用具有显著性（P = 0.04）。性别影响DM在急性PE中的预后影响。患有PE的糖尿病女性的长期死亡风险是男性的两倍，而DM在男性中与死亡率无关。
