Sepsis, Septic Shock Likely Increase Risk of Adverse Outcomes in PAH

Among hospitalized patients who have pulmonary arterial hypertension (PAH) and were admitted for sepsis or septic shock (SSS), higher incidence rates of and worse outcomes from comorbid heart failure were seen, with investigators stressing the importance of managing right ventricular strain in these patients.

Study results were published recently in BMC Pulmonary Medicine from the analysis of data on 1134 adult patients appearing in the National Readmissions Database between 2016 and 2017. Propensity score matching was on the basis of demographic, social, and clinical variables. Their mean age was 65 years, and 67% identified as female. International Classification of Diseases, Tenth Revision codes were used for SSS diagnosis identification.

“Most outcome studies in PAH focus on right heart failure,” the authors wrote. “The current literature lacks in establishing the impact of PAH in patients with SSS.”

Among patients with diagnosed PAH in this study, several chronic diseases were more common among those who also had SSS (all P < .001):

• Congestive heart failure: 56.4% vs 23.5%
• Chronic pulmonary disease: 40.2% vs 28.4%
• Renal failure: 34.6% vs 25.2%
• Coronary artery disease: 27.5% vs 23.1%
• Obesity: 21.5% vs 17.5%
• Coagulation disease: 24.2% vs 14.8%

Overall, the gap in mortality (primary outcome) was determined to be not significant, at 16.5% in the patients with PAH and SSS compared with 15.1% (P = .41) among those with SSS only. However, a matching subanalysis of secondary end points determined that patients who had both more commonly had acute heart failure (24.1% vs 19.6%; P < .001), a longer hospital stay (13.5 vs 10.9 days; P < .001), and greater total hospital costs ($164,252 vs $129,185; P < .001).

Among other secondary outcomes of vasopressor use (P < .236), atrial fibrillation (P < .698), hemorrhagic stroke (P = 1), ischemic stroke (P < .246), and acute instances of myocardial infarction (P < .454) or kidney injury (P < .503), no significant differences were seen.

“Our results indicate that patients with PAH do not have a higher risk of worse clinical outcomes when admitted for sepsis or septic shock, except for acute heart failure,” the study authors concluded. “However, patients with PAH had worse resource utilization outcomes, including length of stay and hospitalization costs.”

They stressed the degree of vulnerability among patients with PAH, in particular those who are older than 50 years, due to their higher chances of comorbidities—especially of the heart. And for those in septic shock, they have an even greater risk for decompensation because of the body’s limited perfusion ability.

It is important to investigate PAH management strategies among these older patients, particularly those that must also consider contributions from sepsis. Not only can this help the patients, but it can mitigate the burden on the health care system, the study investigators emphasized.

Reference

Vasudeva R, Challa A, Tuck N, Pothuru, Vindhyal M. Hospital outcomes for patients with pulmonary arterial hypertension in sepsis and septic shock. BMC Pulm Med. Published online October 3, 2022. doi:10.1186/s12890-022-02145-1