Figures
- FIGURE 1
Cumulative survival after discharge at 3, 6 and 12 months of pulmonary arterial hypertension (PAH) patients admitted to the intensive care unit.
- FIGURE 2
Kaplan–Meier curve of 1-year survival after discharge of pulmonary arterial hypertension (PAH) patients admitted to the intensive care unit by underlying diagnosis (idiopathic PAH (IPAH) versus PAH due to connective tissue diseases (CTD-PAH)).
Tables
- TABLE 1
Characteristics of PAH patients admitted to the ICU
All IPAH CTD-PAH# Other-PAH¶ p-value Subjects n 102 29 57 16 Age upon first admission years 58.7±13.6 53.7±13.5 63.5±11.9 50.6±12.8 <0.001 Female 86 (84.3) 27 (93.1) 51 (89.5) 8 (50.0) <0.001 Race n (White/AA/Hispanic/others) 59/39/2/2 16/12/0/1 36/20/0/1 7/7/2/0 0.05 WHO FC pre-admission n (II/III/IV) 24/59/19 10/15/4 12/36/9 2/8/6 0.002 Time since PAH diagnosis to first ICU admission months, median (IQR) 38.9 (12.4–92.3) 64.5 (25.9–147.3) 39.5 (11.8–92.1) 24.6 (9.7–33.9) 0.002 Haemodynamics at PAH diagnosis RAP mmHg 11±6 12±6 9±6 12±7 0.14 mPAP mmHg 45±14 54±14 39±12 50±15 <0.001 PCWP mmHg 10±4 10±3 11±4 11±4 0.97 Cardiac output L·min−1 4.7±1.9 4.6±2.0 4.8±1.8 4.6±2.1 0.85 Cardiac index L·min−1·m−2 2.19±0.64 2.11±0.53 2.23±0.69 2.12±0.58 0.61 PVR Wood units, median (IQR) 7.7 (4.8–11.8) 10.0 (7.6–14.6) 6.7 (3.0–9.6) 9.4 (5.3−14.0) 0.008 Comorbidities Coronary artery disease 10 (9.8) 4 (13.8) 4 (7.2) 2 (13.0) 0.56 Systemic hypertension 23 (22.6) 8 (27.6) 14 (24.6) 1 (6.3) 0.22 Diabetes mellitus 14 (13.7) 9 (31.0) 3 (5.3) 2 (12.5) 0.005 Peripheral vascular disease 3 (2.9) 0 (0) 2 (3.5) 1 (6.3) 0.45 Cerebrovascular disease 3 (2.9) 0 (0) 2 (3.5) 1 (6.3) 0.45 History of depression 9 (8.8) 1 (3.5) 5 (8.8) 3 (18.8) 0.68 Charlson comorbidity index 0 9 (8.8) 8 (27.6) 0 (0) 1 (6.3) <0.001 1 10 (9.8) 4 (13.8) 6 (10.4) 0 (0) 2 15 (14.7) 6 (20.7) 7 (12.3) 2 (12.5) ≥3 68 (66.7) 11 (37.9) 44 (77.2) 13 (81.2) Data are expressed as mean±sd and n (%) unless otherwise indicated. PAH: pulmonary arterial hypertension; ICU: intensive care unit; IPAH: idiopathic PAH; CTD-PAH: connective tissue diseases PAH; AA: African American; WHO FC: World Health Organization functional class; IQR: interquartile range; RAP: right atrial pressure; mPAP: mean pulmonary artery pressure; PCWP: pulmonary capillary wedge pressure; PVR: pulmonary vascular resistance. #: CTD-PAH includes: 46 scleroderma-associated PAH (SSc-PAH) patients and 11 patients with other CTD-associated PAH conditions; ¶: other-PAH includes: CHD-PAH (3), portopulmonary hypertension-PAH (6) and HIV-associated PAH (7) patients.
- TABLE 2
Characteristics of ICU admissions
All IPAH CTD-PAH Other-PAH# p-value Subjects n 155 45 85 25 Causes of ICU admission Right heart failure 83 (53.5) 27 (60.0) 45 (52.9) 11 (44.0) 0.27 Infection 27 (17.4) 6 (13.3) 16 (18.8) 5 (20.0) 0.54 Arrhythmia 17 (11.0) 5 (11.1) 11 (12.9) 1 (4.0) 0.61 Syncope 13 (8.4) 1 (2.2) 8 (9.4) 4 (16.0) 0.09 Bleeding disorder 8 (5.2) 2 (4.4) 3 (3.5) 3 (12.0) 0.19 Others 7 (4.5) 4 (8.9) 2 (2.4) 1 (4.0) 0.37 Admission data Systolic BP mmHg 105.9±22.1 105.3±15.5 106.8±24.3 103.6±26.6 0.85 Diastolic BP mmHg 62.4±12.9 63.2±9.0 62.9±15.0 58.3±9.9 0.37 Heart rate beats per min 93.7±17.7 94.9±15.1 93.7±18.7 91.1±19.8 0.75 Creatinine mg·dL−1 1.8±1.4 1.8±1.3 1.5±1.2 2.6±2.0 0.006 eGFR <60 mL·min−1 per 1.73 m2 97 (62.6) 26 (57.8) 52 (61.2) 19 (76.0) 0.009 BUN mg·dL−1 34.5±22.3 33.0±21.3 36.2±23.1 31.7±22.0 0.57 Na mEq·mL−1 135.7±6.1 135.2±6.8 136.5±5.9 134.1±4.7 0.16 Na <136 mEq mL−1 74 (47.7) 17 (37.8) 37 (43.5) 20 (80.0) 0.002 Bilirubin, total, mg·dL−1 1.5±1.6 1.7±2.0 1.0±0.9 2.5±2.0 <0.001 Lactate mmol·L−1 2.6±3.1 2.4±2.9 2.6±3.3 3.1±2.9 0.72 Haemoglobin g·dL−1 11.0±2.4 11.6±2.9 10.9±2.1 10.6±2.5 0.15 Anaemia 115 (74.2) 31 (68.9) 63 (74.1) 21 (84.0) 0.38 ProBNP pg·mL−1, median (IQR) 3851 (2229–7000) 3192 (1533–6874) 4727 (2302–6945) 4209 (921–8518) 0.63 ICU support Vasopressors/inotropes 75 (48.4) 19 (42.2) 43 (50.6) 13 (52.0) 0.61 Mechanical ventilation 32 (20.1) 9 (20.0) 17 (20.0) 6 (24.0) 0.90 Renal replacement therapy 9 (5.8) 2 (4.4) 2 (2.4) 5 (20.0) 0.004 Length of ICU stay days, median (IQR) 5 (2–9) 5 (2–8) 5 (3–10) 5 (3–8) 0.60 ICU mortality 42 (27.1) 10 (22.2) 22 (25.9) 10 (40.0) 0.25 Right heart failure, mortality 26 (31.3) 9 (90.0) 12 (54.5) 5 (50.0) 0.31 Infections, mortality 6 (22.2) 0 (0) 5 (22.7) 1 (10.0) 0.76 Vasopressors/inotropes, mortality 32 (42.7) 8 (80.0) 15 (68.2) 9 (90.0) <0.001 Mechanical ventilation, mortality 16 (50.0) 5 (50.0) 7 (31.8) 4 (40.0) 0.001 Data are expressed as mean±sd and n (%) unless otherwise indicated. ICU: intensive care unit; PAH: pulmonary arterial hypertension; IPAH: idiopathic PAH; CTD-PAH: connective tissue diseases PAH; BP: blood pressure; eGFR: estimated glomerular filtration rate; BUN: blood urea nitrogen; Na: sodium; proBNP: pro-B-type natriuretic peptide; IQR: interquartile range. #: other-PAH includes: CHD-PAH (3), portopulmonary hypertension-PAH (11) and HIV-associated PAH (11) admissions.
- TABLE 3
Risk factors for in-hospital mortality in PAH patients admitted to the ICU
Unadjusted
OR (95% CI)p-value Adjusted for PAH diagnosis and age
OR (95% CI)p-value Age per year 1.01 (0.98–1.03) 0.67 NA NA Female versus male 0.47 (0.20–1.10) 0.08 0.57 (0.23–1.40) 0.22 CTD-PAH versus IPAH 1.27 (0.52–2.90) 0.64 1.11 (0.44–2.80)# 0.83 WHO FC pre-admission (III and IV) 4.05 (0.56–29.27) 0.16 3.46 (0.41–26.10) 0.26 Charlson index ≥2 1.94 (0.12–31.89) 0.64 1.30 (0.22–7.80) 0.29 Data on admission Systolic BP per mmHg decrease 0.99 (0.97–1.01) 0.36 0.99 (0.97–1.01) 0.28 Systolic BP <100 mmHg 1.05 (0.51–2.16) 0.88 1.06 (0.51–2.20) 0.87 Anaemia 0.70 (0.32–1.54) 0.37 0.64 (0.29–1.43) 0.28 eGFR <60 mL·min−1 per 1.73 m2 5.27 (1.05–26.60) 0.04 4.65 (0.86–25.10) 0.07 Na <136 mEq·mL−1 3.37 (1.58–7.19) 0.002 3.10 (1.41–6.82) 0.005 ProBNP pg·mL−1 (log transformed) 1.74 (1.04–2.93) 0.036 1.75 (1.03–2.98) 0.03 Bilirubin, total, mg·dL−1 1.39 (1.08–1.78) 0.01 1.40 (1.09–1.80) 0.009 Lactate mmol·L−1 1.40 (0.98–2.02) 0.06 1.42 (1.05–1.93) 0.023 Previous hospitalisation 1.10 (0.52–2.31) 0.89 1.09 (0.52–2.31) 0.81 In-hospital support Need for vasopressors/inotropes 5.21 (2.32–11.68) <0.001 5.29 (2.28–12.28) <0.001 Need for mechanical ventilation 3.73 (1.64–8.47) 0.002 3.76 (1.63–8.67) 0.002 Need for renal replacement therapy 6.11 (1.45–25.81) 0.014 5.57 (1.25–24.76) 0.024 PAH: pulmonary arterial hypertension; ICU: intensive care unit; CTD-PAH: connective tissue diseases PAH; IPAH: idiopathic PAH; WHO FC: World Health Organization functional class; BP: blood pressure; eGFR: estimated glomerular filtration rate; Na: sodium; proBNP: pro-B-type natriuretic peptide. #: adjusted only for age.
- TABLE 4
Risk factors for mortality within the first year after discharge in PAH patients admitted to the ICU
Unadjusted
HR (95% CI)p-value Adjusted for PAH diagnosis and age
HR (95% CI)p-value Age per year 1.02 (1.01–1.04) 0.01 NA NA Female versus male 0.89 (0.49–1.62) 0.70 0.98 (0.53–1.81) 0.93 CTD-PAH versus IPAH 2.31 (1.28–4.16) 0.005 1.89 (1.01–3.59)# 0.05 WHO FC pre-admission (III and IV) 3.24 (0.95–11.02) 0.06 2.99 (0.84–10.63) 0.09 Charlson index ≥2 4.41 (0.53–36.67) 0.17 1.25 (0.35–4.52) 0.72 Data on admission Systolic BP <100 mmHg 1.08 (0.70–1.68) 0.72 1.06 (0.69–1.64) 0.78 Anaemia 0.91 (0.55–1.49) 0.70 0.86 (0.53–1.40) 0.55 eGFR <60 mL·min−1 per 1.73 m2 1.91 (0.76–4.78) 0.16 1.52 (0.59–3.92) 0.38 Na <136 mEq·mL−1 1.87 (1.21–2.89) 0.005 1.71 (1.08–2.69) 0.021 ProBNP pg·mL−1 (log transformed) 1.48 (1.10–1.98) 0.009 1.35 (1.01–1.83) 0.04 Bilirubin, total, mg·dL−1 1.12 (1.00–1.26) 0.06 1.19 (1.05–1.34) 0.006 In-hospital support Need for vasopressors/inotropes 2.73 (1.73–4.30) <0.001 2.57 (1.62–4.08) <0.001 Need for mechanical ventilation 2.05 (1.24–3.38) 0.005 2.06 (1.25–3.40) 0.005 Need for renal replacement therapy 1.80 (0.68–4.76) 0.23 1.91 (0.68–5.38) 0.21 PAH: pulmonary arterial hypertension; ICU: intensive care unit; CTD-PAH: connective tissue diseases PAH; IPAH: idiopathic PAH; WHO FC: World Health Organization functional class; BP: blood pressure; eGFR: estimated glomerular filtration rate; Na: sodium; proBNP: pro-B-type natriuretic peptide. #: adjusted only for age.
