In-hospital mortality due to pulmonary embolism in patients with Alzheimer disease: a sex effect?

Abstract

Older adults with dementia are frequent Emergency Department (ED) visitors, have greater comorbidity, are admitted to hospitals at higher rates, and have higher mortality than patients without dementia. Alzheimer's disease (AD) is the sixth leading cause of death in the United States and pulmonary embolism (PE) ranks second among causes of out-of-hospital sudden death. The study aimed to evaluate the relationship between in-hospital mortality (IHM) and PE, comorbidities, and possible gender differences in a consecutive cohort of patients. The study included all cases of patients referred to the Emergency Department and admitted to internal medicine wards (2000–2013, at the Hospital of Ferrara, Italy. Total sample consisted of 8,201 patients (63.9% females; mean age 79.7±12 years). Mean CCI adjusted for age and dementia was 1.99±1.82, and 631 subjects (7.7%) died during hospitalization. PE was diagnosed in 83 patients (1%), with 17 (20.5%) fatal cases. Deceased patients were older (80.7±11.7 vs. 79.7±12, p=0.041), more frequently males (10.2% vs. 6.3%, p<0.001), and more likely to have PE (2.7% vs. 0.9%, p<0.001). Logistic regression analysis showed that IHM was significantly associated with PE, male sex, and age. In our population, representative of the Italian geriatric population as a whole, PE was significantly associated with IHM in AD patients, together with age but, especially, male sex. This study, representative of the real world of elderly patients and everyday clinical practice, seems to show a gender effect, since women are more affected by AD, but fatal PEs are more likely to occur in males