David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
BMC Pulm Med. 2024 Oct 28;24(1):538. doi: 10.1186/s12890-024-03355-5.
Sepsis is a common cause of death in patients with pulmonary arterial hypertension (PAH). Treatment requires careful fluid management and hemodynamic support. This study compares patients with or without PAH presenting with sepsis with a focus on initial fluid resuscitation.
This retrospective analysis compared adults with and without PAH admitted for sepsis at two academic hospitals between 2013 and 2022. Prior PAH diagnosis was verified by review of right heart catheterization data and sepsis present on admission was verified by chart review. Demographics, vital signs, laboratory values, imaging results, treatment approaches, and all-cause mortality data were obtained. Controls were propensity score weighted by age, sex, and Charlson Comorbidity index. Logistic regression models controlling for age and Charlson comorbidity indices were used to examine factors associated with survival.
Thirty patients admitted for sepsis with pre-existing PAH were compared to 96 matched controls. Controls received significantly more fluids at 24 h compared to PAH patients (median 0 mL v. 1216 mL, p < 0.001), while PAH patients were more likely to receive vasoactive medications (23.3% vs. 8.3%, p = 0.037). At 30 days, 7 PAH patients (23.3%) and 13 control patients (13.5%) had died (p = 0.376). PAH patients that received more fluids had decreased mortality (OR 0.31, 95% CI 0.11-0.92, p = 0.03) and patients who received fluids had shorter mean time to antibiotics (2.3 h v. 6.5 h, p = 0.04), although decreased time to antibiotics was not associated with mortality. Patients who received no fluids more often had previously identified right ventricular systolic dysfunction (62.5% v. 28.6%, p = 0.136).
Patients with PAH and sepsis have high mortality and receive different treatments than controls, with more reliance on vasopressors and less on fluid resuscitation. PAH patients who received less fluids had higher mortality and those who received no fluids had a longer time to receiving antibiotics, indicating a potential delay in recognizing sepsis. Timely recognition of sepsis and dynamic decision-making around fluid resuscitation remains critical in this high-risk population.
脓毒症是肺动脉高压（PAH）患者死亡的常见原因。治疗需要谨慎的液体管理和血流动力学支持。本研究比较了患有和不患有 PAH 的脓毒症患者，重点是初始液体复苏。
本回顾性分析比较了 2013 年至 2022 年期间在两家学术医院因脓毒症入院的成年患者，其中包括有和没有 PAH 的患者。通过右心导管检查数据回顾验证既往 PAH 诊断，入院时通过图表审查验证脓毒症的存在。获取了人口统计学、生命体征、实验室值、影像学结果、治疗方法和全因死亡率数据。对照通过年龄、性别和 Charlson 合并症指数进行倾向评分加权。使用控制年龄和 Charlson 合并症指数的逻辑回归模型来检查与生存相关的因素。
将 30 名因 PAH 而入院的脓毒症患者与 96 名匹配的对照进行比较。与 PAH 患者相比，对照组在 24 小时内接受的液体量明显更多（中位数分别为 0 毫升和 1216 毫升，p<0.001），而 PAH 患者更有可能接受血管活性药物（23.3% 对 8.3%，p=0.037）。在 30 天内，7 名 PAH 患者（23.3%）和 13 名对照患者（13.5%）死亡（p=0.376）。接受更多液体的 PAH 患者死亡率降低（OR 0.31，95%CI 0.11-0.92，p=0.03），接受液体的患者接受抗生素的平均时间更短（2.3 小时对 6.5 小时，p=0.04），尽管接受抗生素的时间缩短与死亡率无关。接受无液体治疗的患者更常出现先前确定的右心室收缩功能障碍（62.5% 对 28.6%，p=0.136）。
患有 PAH 和脓毒症的患者死亡率较高，与对照相比接受不同的治疗，更依赖血管加压素，而较少依赖液体复苏。接受较少液体的 PAH 患者死亡率更高，而接受无液体治疗的患者接受抗生素的时间更长，这表明在识别脓毒症方面可能存在延迟。及时识别脓毒症并围绕液体复苏进行动态决策仍然是高危人群的关键。
