Background and importance 

Marked differences have been described between women and men in disease prevalence, clinical presentation, response to treatment and outcomes. However, such data are scarce in the acutely ill. An awareness of differences related to biological sex is essential for the success of clinical care and outcomes in patients presenting with acute dyspnea, the most frequent cause of emergency department (ED) admission.

Objectives 

The aim of the present study was to assess the effect of biological sex on 1-year all-cause mortality in patients presenting with acute dyspnea to the ED.

Design, settings and participants 

Consecutive adult patients presenting with acute dyspnea in two Lithuanian EDs were included. Clinical characteristics, laboratory data and medication use at discharge were collected. Follow-up at 1 year was performed via national data registries.

Outcomes measure and analysis 

The primary outcome of the study was 1-year all-cause mortality. Hazard ratios (HRs) for 1-year mortality according to biological sex were calculated using a Cox proportional hazards regression model, with and without adjustment for the following confounders: age, systolic blood pressure, creatinine, sodium and hemoglobin.

Main results 

A total of 1455 patients were included. Women represented 43% of the study population. Compared to men, women were older [median (interquartile range [IQR]) age 74 (65–80) vs. 68 (59–77) years, P < 0.0001]. The duration of clinical signs before admission was shorter for women [median (IQR) duration 4 (1–14) vs. 7(2–14) days, P = 0.006]. Unadjusted 1-year all-cause mortality was significantly lower in women (21 vs. 28%, P = 0.001). Adjusted HR of 1-year all-cause mortality was lower in women when compared to men [HR 0.68 (0.53–0.88), P = 0.0028]. Additional sensitivity analyses confirmed the survival benefit for women in subgroups including age greater and lower than 75 years, the presence of comorbidities and causes of dyspnea (cardiac or noncardiac).

Conclusion 

Women have better 1-year survival than men after the initial ED presentation for acute dyspnea. Understanding the biological sex-related differences should lead toward precision medicine, and improve clinical decision-making to promote gender equality in health.

中文翻译：

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急诊科急性呼吸困难患者生理性别与长期预后的关系

背景和重要性 

女性和男性在疾病流行率、临床表现、对治疗的反应和结果方面存在显着差异。然而，这些数据在重症患者中很少见。意识到与生理性别相关的差异对于急性呼吸困难患者的临床护理和结果的成功至关重要，急性呼吸困难是急诊科 (ED) 入院的最常见原因。

目标 

本研究的目的是评估生理性别对急诊室急性呼吸困难患者 1 年全因死亡率的影响。

设计、设置和参与者 

包括在两个立陶宛急诊室出现急性呼吸困难的连续成年患者。收集临床特征、实验室数据和出院时的药物使用情况。通过国家数据登记处进行了 1 年的随访。

结果测量和分析 

该研究的主要结果是 1 年全因死亡率。使用 Cox 比例风险回归模型计算根据生物学性别的 1 年死亡率的风险比 (HR)，调整和不调整以下混杂因素：年龄、收缩压、肌酐、钠和血红蛋白。

主要结果 

共纳入 1455 名患者。女性占研究人群的 43%。与男性相比，女性年龄较大 [中位数（四分位距 [IQR]）年龄 74（65-80）对 68（59-77）岁，P < 0.0001]。女性入院前临床症状的持续时间较短[中位 (IQR) 持续时间 4 (1-14) 天 vs. 7 (2-14) 天，P = 0.006]。女性未调整的 1 年全因死亡率显着降低（21% vs. 28%，P = 0.001）。与男性相比，女性 1 年全因死亡率的调整后 HR 较低 [HR 0.68 (0.53–0.88)，P= 0.0028]。额外的敏感性分析证实了包括年龄大于和小于 75 岁、合并症和呼吸困难原因（心源性或非心源性）在内的亚组女性的生存获益。

结论 

因急性呼吸困难首次急诊就诊后，女性的 1 年生存率高于男性。了解与生物性别相关的差异应该导致精准医学，并改善临床决策以促进健康中的性别平等。