Critical care outcomes in patients with pre-existing pulmonary hypertension: insights from the ASPIRE registry
- K. Bauchmuller1,4,
- R. Condliffe2,3,4,
- J. Southern1,4,
- C. Billings2,
- A. Charalampopoulos2,
- C. A. Elliot2,
- A. Hameed2,
- D. G. Kiely2,3,
- I. Sabroe2,
- A. A. R. Thompson2,3,
- A. Raithatha1 and
- G. H. Mills1,3,4
- 1Department of Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- 2Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- 3Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- 4Contributed equally
- Dr Kris Bauchmuller, Department of Critical Care and Anaesthesia, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield, S10 2 JF, UK. E-mail: Kris.bauchmuller{at}nhs.net
Abstract
Pulmonary Hypertension (PH) is a life-shortening condition characterised by episodes of decompensation precipitated by factors such as disease progression, arrhythmias and sepsis. Surgery and pregnancy also place additional strain on the right ventricle. Data on critical care management in patients with pre-existing PH are scarce.
We conducted a retrospective observational study of a large cohort of patients admitted to the critical care unit of a national referral centre between 2000–17 to establish acute mortality, evaluate predictors of in-hospital mortality and establish longer-term outcomes in survivors to hospital discharge.
242 critical care admissions involving 206 patients were identified. Hospital survival was 59.3%, 94% and 92% for patients admitted for medical, surgical or obstetric reasons. Medical patients had more severe physiological and laboratory perturbations than patients admitted following surgical or obstetric interventions. Higher APACHE II score, age and lactate, and lower SpO2/FiO2, platelet count and sodium level were identified as independent predictors of hospital mortality. An exploratory risk score, OPALS (Oxygen (SpO2:FiO2), ≤185; Platelets, ≤196×109·L−1; Age, ≥37.5 years; Lactate, ≥2.45 mmol·L−1; Sodium, ≤130.5 mmol·L−1), identified medical patients at increasing risk of hospital mortality. One of nine patients (11%) who were invasively ventilated for medical decompensation and 50% of patients receiving renal replacement therapy left hospital alive. There was no significant difference in exercise capacity or functional class between follow-up and pre-admission in patients who survived to discharge.
These data have clinical utility in guiding critical care management of patients with known PH. The exploratory OPALS score requires validation.
Footnotes
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Conflict of interest: Dr. Kris Bauchmuller has nothing to disclose.
Conflict of interest: R. Condliffe reports honoraria for lecturing and advisory boards from Actelion and MSD outside the submitted work.
Conflict of interest: Dr. Southern has nothing to disclose.
Conflict of interest: Catherine Billings has nothing to disclose.
Conflict of interest: Dr. Charalampopoulos has nothing to disclose.
Conflict of interest: Elliot received lecture and consultancy fees from Actelion, Bayer and GSK pharmaceuticals.
Conflict of interest: Dr. Hameed has nothing to disclose.
Conflict of interest: Dr. Kiely reports grants, personal fees and other from Actelion, grants, personal fees and other from Bayer, grants, personal fees and other from GSK, personal fees and other from MSD, outside the submitted work; .
Conflict of interest: Dr. Sabroe has nothing to disclose.
Conflict of interest: A.A.R. Thompson reports an Intermediate Clinical Fellowship (FS/18/13/3328) from the British Heart Foundation during the conduct of the study and support for travel to attend educational meetings from Actelion Pharmaceuticals Ltd outside the submitted work.
Conflict of interest: Dr Raithatha has nothing to disclose.
Conflict of interest: Dr. Mills has nothing to disclose.
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- Received January 20, 2021.
- Accepted January 31, 2021.
- ©The authors 2021
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