Li Dong-Kai, Mao Jia-Yu, Long Yun, Liu Da-Wei, Wang Xiao-Ting
Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
Pulm Circ. 2020 Jul 10;10(3):2045894020933087. doi: 10.1177/2045894020933087. eCollection 2020 Jul-Sep.
Pulmonary hypertension (PH) occurs in patients with acute respiratory distress syndrome (ARDS); the most severe form comprises acute cor pulmonale (ACP). Here, we investigated the prevalence of PH in patients with ARDS to evaluate its correlation with ACP risk, ARDS severity and central venous pressure (CVP). We conducted a secondary analysis using data from the MIMIC-III open-source clinical database. The prevalence of PH associated with new-onset ARDS during the first 72 h after intensive care unit admission was investigated; moreover, the association between ACP risk score and PH was validated. We also evaluated the association between elevated CVP (mean CVP > 10 mmHg) and PH and other clinical outcomes. Among 2434 patients who met the ARDS Berlin criteria and underwent echocardiography or pulmonary artery catheterization evaluation, a total of 583 (24.0%) patients were diagnosed with moderate or severe PH, of which 418 had low and 165 had high ACP risk. After adjustment for disease/ARDS severity, ACP risk score, and other demographic variables, elevated CVP was independently associated with the occurrence of PH (odds ratio, 2.239 (1.674, 2.993), < 0.005). Among patients with PH, higher mean CVP was associated with prolonged hospital stay (13.4 vs. 15.2 days, = 0.041) and duration of ventilation (116.5 vs. 150.5 h, = 0.023). Incidence of PH was 24.0% in patients with new-onset ARDS in this retrospective study. Elevated CVP is relevant with higher incidence of PH and worse clinical outcome; these highlighted the importance of hemodynamic monitoring in the management of ARDS.
肺动脉高压（PH）发生于急性呼吸窘迫综合征（ARDS）患者中；最严重的形式包括急性肺心病（ACP）。在此，我们调查了ARDS患者中PH的患病率，以评估其与ACP风险、ARDS严重程度及中心静脉压（CVP）的相关性。我们使用来自MIMIC-III开源临床数据库的数据进行了二次分析。研究了重症监护病房入院后最初72小时内与新发ARDS相关的PH患病率；此外，还验证了ACP风险评分与PH之间的关联。我们还评估了CVP升高（平均CVP>10 mmHg）与PH及其他临床结局之间的关联。在2434例符合ARDS柏林标准并接受超声心动图或肺动脉导管插入术评估的患者中，共有583例（24.0%）患者被诊断为中度或重度PH，其中418例ACP风险低，165例ACP风险高。在对疾病/ARDS严重程度、ACP风险评分及其他人口统计学变量进行校正后，CVP升高与PH的发生独立相关（比值比，2.239（1.674，2.993），P<0.005）。在PH患者中，较高的平均CVP与住院时间延长（13.4天对15.2天，P=0.041）和通气时间延长（116.5小时对150.5小时，P=0.023）相关。在这项回顾性研究中，新发ARDS患者的PH发生率为24.0%。CVP升高与PH的较高发生率及较差的临床结局相关；这些突出了血流动力学监测在ARDS管理中的重要性。
