Pulmonary Embolism Symptoms Affected by Disease Severity, Sex, Age, BMI

Individuals with high-risk pulmonary embolism, regardless of their age or sex, are likely to exhibit dyspnea, syncope and tachycardia.

Symptoms of pulmonary embolism (PE) vary by sex, age, disease severity, and body mass index (BMI); younger men with acute PE are more likely to exhibit hemoptysis and pneumonia, while older patients with low-risk PE are more likely to have syncope. These are among study findings reported in BMJ Open Respiratory Research.

Investigators sought to explore the relationships between clinical presentation of acute PE, patient characteristics, PE severity, and mortality. Toward that end, the researchers conducted a retrospective, observational, cohort study using data from the Regional PE Registry (REPER).

A total of 1242 consecutive patients with acute PE were enrolled from 2015 to the end of 2021. All participants had signs and symptoms of acute PE within the previous 14 days, and a thrombus was diagnosed at admission in at least 1 segmental pulmonary artery on computed tomography-pulmonary angiography.

Study participants were divided into 4 groups based on sex and age: (1) younger men (<63 years); (2) older men (≥63 years); (3) younger women (<69 years); (4) older women (≥69 years). From there they were also subdivided based on BMI into 3 subgroups: normal weight (18.5 to 24.9 kg/m2); overweight (25.0 to 29.9 kg/m2); and obese (>30 kg/m2). Participants were also stratified according to PE risk level based on the European Society of Cardiology mortality risk model.

Awareness that the signs and symptoms of acute PE depend on disease severity, sex, age, and BMI might contribute to its prompt diagnosis and treatment.

The incidence of hemoptysis in the intermediate-risk and high-risk PE groups was significantly different in the 4 patient groups. For intermediate-high risk PE, younger and older men had an increased incidence of hemoptysis vs younger and older women (11.7% and 7.5% vs 5.9% and 2.3%, respectively; P =.010). Younger men also had the greatest frequency of hemoptysis in high-risk PE (13.8%) compared with older men, younger women, and older women (2.5%, 0.0%, 3.7%, respectively; P =.031). In the cohort of younger women, hemoptysis incidence decreased with an increase in PE risk (10.5% for low risk vs 5.9% for intermediate risk vs 0.0% for high risk, P =.047).

The incidence of lower limb deep vein thrombosis was not significantly different in the 4 groups of patients. In lower-risk PE patients, chest pain frequently occurred in men and younger women, but rarely in older women (55.5% in younger men vs 48.8% in older men vs 51.9% in younger women vs 35.8% in older women, P =.023. An increased incidence of chest pain for low-risk PE group vs intermediate-risk and high-risk PE was seen in older men (48.8% low risk vs 34.7% intermediate risk vs 30.0% high risk, P =.048) and younger women (51.9% low risk vs 36.8% intermediate risk vs 22.7% high risk, P =.001).

In all groups except for older men, the presence of dyspnea increased significantly from low- to high-risk PE; in older men, the increase was nonsignificant. Syncope was common in older men and women in the low-risk PE cohort and was rare in younger men and women (15.5% and 11.3% in older men and women, respectively, vs 4.5% in both younger subgroups, P =.009).

Tachycardia incidence was increased for younger men and women with intermediate-high PE (57.9% and 52.6% in younger men and women vs 42.8% and 40.15 in older men and women, P =.004).

Pneumonia was more common in younger men with low-risk PE (31.8%) vs older men (15.3%) vs younger women (10.5%) vs older women (14.2%) (P < .001) as well as in young men with intermediate-risk PE (25.5% vs 17.5% for older men, 18.4% for younger women, and 12.9% for older women; P =.036).

Study limitations include the retrospective analysis of registry data and some missing and erroneous data, with more missing data likely in high-risk patients.

“Awareness that the signs and symptoms of acute PE depend on disease severity, sex, age, and BMI might contribute to its prompt diagnosis and treatment,” the researchers commented.

This article originally appeared on Pulmonology Advisor


Ružičić DP, Dzudovic B, Matijasevic J, et al. Signs and symptoms of acute pulmonary embolism and their predictive value for all-cause hospital death in respect of severity of the disease, age, sex and body mass index: retrospective analysis of the Regional PE Registry (REPER). BMJ Open Respir Res. 2023;10(1):e001559. doi: 10.1136/bmjresp-2022-001559