1 Ružičić DP, et al. BMJ Open Resp Res 2023;10:e001559. doi:10.1136/bmjresp-2022-001559 To cite: 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 Resp Res 2023;10:e001559. doi:10.1136/ bmjresp-2022-001559 ► Additional supplemental material is published online only. To view, please visit the journal online (http://dx.doi. org/10.1136/bmjresp-2022- 001559). Received 21 November 2022 Accepted 31 March 2023 For numbered affiliations see end of article. Correspondence to Professor Slobodan Obradovic; sloba.d.obradovic@gmail. com 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) Dušan Predrag Ružičić , 1 Boris Dzudovic, 2,3 Jovan Matijasevic, 4,5 Marija Benic, 4 Sonja Salinger, 6,7 Ljiljana Kos, 8 Tamara Kovacevic-Preradovic, 8,9 Irena Mitevska, 10 Aleksandar Neskovic, 11,12 Bjanka Bozovic, 13 Nebojsa Bulatovic, 13,14 Vladimir Miloradovic, 15,16 Ivica Djuric, 17 Slobodan Obradovic 3,17 Pulmonary vasculature © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. ABSTRACT Background The incidence of the signs and symptoms of acute pulmonary embolism (PE) according to mortality risk, age and sex has been partly explored. Patients and methods A total of 1242 patients diagnosed with acute PE and included in the Regional Pulmonary Embolism Registry were enrolled in the study. Patients were classifed as low risk, intermediate risk or high risk according to the European Society of Cardiology mortality risk model. The incidence of the signs and symptoms of acute PE at presentation with respect to sex, age, and PE severity was investigated. Results The incidence of haemoptysis was higher in younger men with intermediate-risk (11.7% vs 7.5% vs 5.9% vs 2.3%; p=0.01) and high-risk PE (13.8% vs 2.5% vs 0.0% vs 3.1%; p=0.031) than in older men and women. The frequency of symptomatic deep vein thrombosis was not signifcantly different between subgroups. Older women with low-risk PE presented with chest pain less commonly (35.8% vs 55.8% vs 48.8% vs 51.9%, respectively; p=0.023) than men and younger women. However, younger women had a higher incidence of chest pain in the lower-risk PE group than in the intermediate- risk and high-risk PE subgroups (51.9%, 31.4% and 27.8%, respectively; p=0.001). The incidence of dyspnoea (except in older men), syncope and tachycardia increased with the risk of PE in all subgroups (p<0.01). In the low-risk PE group, syncope was present more often in older men and women than in younger patients (15.5% vs 11.3% vs 4.5% vs 4.5%; p=0.009). The incidence of pneumonia was higher in younger men with low-risk PE (31.8% vs<16% in the other subgroups, p<0.001). Conclusion Haemoptysis and pneumonia are prominent features of acute PE in younger men, whereas older patients more frequently have syncope with low-risk PE. Dyspnoea, syncope and tachycardia are symptoms of high- risk PE irrespective of sex and age. INTRODUCTION Recent advances in the diagnosis and treat- ment of acute pulmonary embolism (PE) have significantly improved patient prog- noses. 1 However, its clinical presentation is variable, and proper management depends on prompt diagnosis. 2–4 The most common symptoms of PE are dyspnoea, pleuritic chest pain and cough. 4–7 The correlation between clinical presentation and PE severity has not been investigated, and this relationship may change over time. Thus, there is some recent evidence that age and the presence of comor- bidities could be associated with some clinical presentations of acute PE, such as pulmonary infarction, which has been demonstrated more in younger patients with fewer comorbidities, 8 WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ Haemoptysis, deep vein thrombosis, chest pain, dyspnoea, syncope, tachycardia and secondary pneumonia are associated with acute pulmonary embolism (PE). WHAT THIS STUDY ADDS ⇒ The incidence of the signs and symptoms of acute PE varies depending on disease severity, sex, age and body mass index (BMI). HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY ⇒ 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. on June 1, 2024 by guest. Protected by copyright. http://bmjopenrespres.bmj.com/ BMJ Open Resp Res: first published as 10.1136/bmjresp-2022-001559 on 19 April 2023. Downloaded from