Outcomes and prognostic factors of decompensated pulmonary hypertension in the intensive care unit

• Published in: Respiratory medicine 2021-12, Vol.190, p.106685-106685, Article 106685
• Main Authors: Garcia, Marcos Vinicius Fernandes, Souza, Rogerio, Costa, Eduardo Leite Vieira, Fernandes, Caio Julio Cesar Santos, Jardim, Carlos Viana Poyares, Caruso, Pedro
• Format: Article
• Language: English
• Subjects: Adult; Brazil - epidemiology; Chronic thromboembolic pulmonary hypertension; Cohort Studies; ECS/ERS risk assessment; Female; Hospital Mortality; Humans; Hypertension, Pulmonary - mortality; Intensive care unit; Intensive Care Units; Lactic Acid - blood; Male; Middle Aged; Natriuretic Peptide, Brain - blood; Organ Dysfunction Scores; Oxygen Saturation; Prognosis; Pulmonary arterial hypertension; Pulmonary hypertension; Retrospective Studies; Severity of Illness Index; SOFA score
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2021.106685

Patients with acute decompensation of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) admitted to intensive care unit (ICU) have high in-hospital mortality. We hypothesized that pulmonary hypertension (PH) severity, measured by a simplified version of European Society of Cardiology/European Respiratory Society (ESC/ERS) risk assessment, and the severity of organ dysfunction upon ICU admission, measured by sequential organ failure assessment score (SOFA) were associated with in-hospital mortality in decompensated patients with PAH and CTEPH. We also described clinical and laboratory variables during ICU stay. Observational study including adults with decompensated PAH or CTEPH with unplanned ICU admission between 2014 and 2019. Multivariate logistic regression models were used to evaluate the association of ESC/ERS risk assessment and SOFA score with in-hospital mortality. ESC/ERS risk assessment and SOFA score were included in a decision tree to predict in-hospital mortality. 73 patients were included. In-hospital mortality was 41.1%. ESC/ERS high-risk group (adjusted odds ratio = 95.52) and SOFA score (adjusted odds ratio = 1.80) were associated with in-hospital mortality. The decision tree identified four groups with in-hospital mortality between 8.1% and 100%. Nonsurvivors had a lower central venous oxygen saturation, higher arterial lactate and higher brain natriuretic peptide in the end of first week in the ICU. High-risk on a simplified version of ERS/ESC risk assessment and SOFA score upon ICU admission are associate with in-hospital mortality. A decision tree based on ESC/ERS risk assessment and SOFA score identifies four groups with in-hospital mortality between 8.1% and 100%. •In-hospital mortality is 41% in patients with decompensated pulmonary hypertension.•ESC/ERS risk assessment and SOFA predict hospital mortality in decompensated PH.•A decision tree based on PH risk assessment and SOFA can predict hospital mortality.•The decision tree identified patients with high hospital mortality at ICU admission.