Divisao de Pneumologia, Instituto do Coracao, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
Divisao de Pneumologia, Instituto do Coracao, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
Respir Med. 2021 Dec;190:106685. doi: 10.1016/j.rmed.2021.106685. Epub 2021 Nov 20.
Patients with acute decompensation of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) admitted to intensive care unit (ICU) have high in-hospital mortality. We hypothesized that pulmonary hypertension (PH) severity, measured by a simplified version of European Society of Cardiology/European Respiratory Society (ESC/ERS) risk assessment, and the severity of organ dysfunction upon ICU admission, measured by sequential organ failure assessment score (SOFA) were associated with in-hospital mortality in decompensated patients with PAH and CTEPH. We also described clinical and laboratory variables during ICU stay.
Observational study including adults with decompensated PAH or CTEPH with unplanned ICU admission between 2014 and 2019. Multivariate logistic regression models were used to evaluate the association of ESC/ERS risk assessment and SOFA score with in-hospital mortality. ESC/ERS risk assessment and SOFA score were included in a decision tree to predict in-hospital mortality.
73 patients were included. In-hospital mortality was 41.1%. ESC/ERS high-risk group (adjusted odds ratio = 95.52) and SOFA score (adjusted odds ratio = 1.80) were associated with in-hospital mortality. The decision tree identified four groups with in-hospital mortality between 8.1% and 100%. Nonsurvivors had a lower central venous oxygen saturation, higher arterial lactate and higher brain natriuretic peptide in the end of first week in the ICU.
High-risk on a simplified version of ERS/ESC risk assessment and SOFA score upon ICU admission are associate with in-hospital mortality. A decision tree based on ESC/ERS risk assessment and SOFA score identifies four groups with in-hospital mortality between 8.1% and 100%.
因急性失代偿性肺动脉高压（PAH）和慢性血栓栓塞性肺动脉高压（CTEPH）而入住重症监护病房（ICU）的患者院内死亡率较高。我们假设通过欧洲心脏病学会/欧洲呼吸学会（ESC/ERS）风险评估简化版测量的肺动脉高压（PH）严重程度，以及 ICU 入院时器官功能障碍严重程度（SOFA 评分）与失代偿性 PAH 和 CTEPH 患者的院内死亡率相关。我们还描述了 ICU 期间的临床和实验室变量。
本观察性研究纳入了 2014 年至 2019 年间因计划外 ICU 入院而出现失代偿性 PAH 或 CTEPH 的成年患者。使用多变量逻辑回归模型评估 ESC/ERS 风险评估和 SOFA 评分与院内死亡率的相关性。ESC/ERS 风险评估和 SOFA 评分被纳入决策树以预测院内死亡率。
共纳入 73 例患者，院内死亡率为 41.1%。ESC/ERS 高危组（调整后的优势比=95.52）和 SOFA 评分（调整后的优势比=1.80）与院内死亡率相关。决策树确定了四个院内死亡率在 8.1%至 100%之间的组。在 ICU 治疗的第一周结束时，非幸存者的中心静脉血氧饱和度较低，动脉血乳酸和脑利钠肽较高。
简化版 ESC/ERS 风险评估和 ICU 入院时的 SOFA 评分高与院内死亡率相关。基于 ESC/ERS 风险评估和 SOFA 评分的决策树可确定四个院内死亡率在 8.1%至 100%之间的组。
