Pulmonary hypertension in ICU patients was associated with significantly lower survival at 365 days compared to patients without pulmonary hypertension (60.8% vs 73.9%; p<0.001).
Cohort (n=65,335)
No
Does a diagnosis of pulmonary hypertension affect mortality and clinical trajectories in patients admitted to the ICU?
A diagnosis of pulmonary hypertension in ICU patients is associated with a significant mortality burden, with 365-day survival significantly lower than in patients without pulmonary hypertension.
Absolute Event Rate: 60.8% vs 73.9%
p-value: p=<.001
Abstract Introduction The presentation of pulmonary hypertension (PH) varies widely, however, the clinical outcomes and trajectories for patients admitted to the ICU remain unclear. This study aims to highlight the clinical characteristics and outcomes of patients with PH in the ICU. Methods We conducted a retrospective cohort study analyzing the MIMIC-IV database. The cohort included 357,931 admitted patients at a single institution between 2008-2022. PH was identified using ICD-9 and 10 codes. Index hospitalization was selected based on the occurrence of death or longest hospitalization. Data coding and statistical analysis were performed using Python and R. Results Of 65,335 patients admitted to the ICU, 7,151 had a diagnosis of PH. Table 1 shows demographic and baseline characteristics. Unspecified PH was reported in 88.8% cases (n = 6,326). Group 1 represented 4.1% (n = 308), Group 2 3.0% (n = 213), and Group 3 1.4% (n = 98) of cases. 6.2% (n = 443) of patients required CRRT. A total of 43.9% of patients received NIPPV or were intubated. Of these, 73.7% (n = 2,313) were on NIPPV and then intubated, 24.2% (n = 760) were on NIPPV but not intubated, and 2% (n = 64) were intubated without receiving NIPPV. The median duration of NIPPV was 24.3 (IQR 80.2) hours. Those who were ultimately intubated had longer NIPPV (37 (IQR 108) vs 28.6 (IQR 87); p.05). Median ICU stay was 3.1 (IQR 4.6) days and total hospital stay was 9 (IQR 11) days. . In-hospital mortality was 20.2% and reached 51.6% over the study period. Renal disease (HR 1.34, 95% CI 1.20 to 1.51; p .001) and CHF (HR 1.25; 95% CI 1.11 to 1.42; p =.0003) were associated with higher mortality, while chronic pulmonary diseases (HR 1.09; 95% CI 0.98 to 1.21; p = 0.11) and rheumatological diseases (HR 1.20; 95% CI 0.954 to 1.52; p =.117) were not. 34.6% of patients on NIPPV and 21.7% of those ultimately intubated did not survive hospitalization (p .001). No difference in in-hospital mortality or survival at 365 days was noted between PH subgroups or across races. Kaplan-Meier analysis showed survival at 365 days to be 60.8% for those with PH compared to 73.9% for those without (log-rank test p .001). Conclusion The diagnosis of PH carries a significant mortality burden. Further studies are needed to evaluate whether delays in intubation reflect the observed variation in mortality. This abstract is funded by: None
Abdulelah et al. (Fri,) conducted a cohort in Pulmonary hypertension (n=65,335). Pulmonary hypertension vs. No pulmonary hypertension was evaluated on Survival at 365 days (p=<.001). Pulmonary hypertension in ICU patients was associated with significantly lower survival at 365 days compared to patients without pulmonary hypertension (60.8% vs 73.9%; p<0.001).
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