Aga Khan University Hospital, Nairobi, KE.
Glob Heart. 2020 Feb 6;15(1):6. doi: 10.5334/gh.384.
Pulmonary hypertension is poorly studied in Africa. The long-term survival rates and prognostic factors associated with mortality in patients with moderate to severe pulmonary hypertension (PH) in Africa are not well described.
To determine the causes of moderate to severe PH in patients seen in contemporary hospital settings, determine the patients' one-year survival and the factors associated with mortality following standard care.
A retrospective review of patients diagnosed with moderate to severe PH at Aga Khan University Hospital (AKUHN) from August 2014 to July 2017 was carried out. Clinical and outcome data were collected from medical records and the hospital mortality database. Telephone interviews were conducted for patients who died outside the hospital. Survival analysis was done using Kaplan-Meier, and log-rank tests were used to assess differences between subgroups. Cox regression modelling with multivariable adjustment was used to identify factors associated with all-cause mortality.
A total of 659 patients with moderate to severe PH were enrolled. Median follow-up time was 626 days. The survival rates of the patients at 1 and 2 years were 73.8% and 65.9%, respectively. The following variables were significantly associated with mortality: diabetes mellitus [adjusted HR 1.52, 95% CI (1.14-2.01)], WHO functional class III/IV [adjusted HR 3.49, 95% CI (2.46-4.95)], atrial fibrillation [adjusted HR 1.53, 95% CI (1.08-2.17)], severe PH [adjusted HR 1.72, 95% CI (1.30-2.27)], right ventricular dysfunction [adjusted HR 2.42, 95% CI (1.76-3.32)] and left ventricular dysfunction [adjusted HR 1.91, 95% CI (1.36-2.69)]. Obesity [adjusted HR 0.68, 95% CI (0.50-0.93)] was associated with improved survival.
Pulmonary hypertension is associated with poor long-term outcomes in African patients. Identification of prognostic factors associated with high-risk patients will assist in patient management and potentially improved outcomes.
在非洲，肺动脉高压研究不足。在非洲，中度至重度肺动脉高压（PH）患者的长期生存率和与死亡率相关的预后因素尚不清楚。
确定在当代医院环境中就诊的中度至重度 PH 患者的病因，确定患者在接受标准治疗后的一年生存率以及与死亡率相关的因素。
对 2014 年 8 月至 2017 年 7 月在阿迦汗大学医院（AKUHN）诊断为中度至重度 PH 的患者进行回顾性分析。从病历和医院死亡率数据库中收集临床和结局数据。对在院外死亡的患者进行电话访谈。采用 Kaplan-Meier 进行生存分析，对数秩检验用于评估亚组之间的差异。采用 Cox 回归模型进行多变量调整，以确定与全因死亡率相关的因素。
共纳入 659 例中度至重度 PH 患者。中位随访时间为 626 天。患者在 1 年和 2 年的生存率分别为 73.8%和 65.9%。以下变量与死亡率显著相关：糖尿病[校正 HR 1.52，95%CI（1.14-2.01）]、世界卫生组织（WHO）功能分级 III/IV[校正 HR 3.49，95%CI（2.46-4.95）]、心房颤动[校正 HR 1.53，95%CI（1.08-2.17）]、重度 PH[校正 HR 1.72，95%CI（1.30-2.27）]、右心室功能障碍[校正 HR 2.42，95%CI（1.76-3.32）]和左心室功能障碍[校正 HR 1.91，95%CI（1.36-2.69）]。肥胖[校正 HR 0.68，95%CI（0.50-0.93）]与生存改善相关。
在非洲患者中，肺动脉高压与预后不良相关。识别与高危患者相关的预后因素将有助于患者管理，并可能改善结局。
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