Deng Huibiao, Wang Peng, Liu Minxing
Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201620, China.
Department of Emergency, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Gusu District, Suzhou City, Jiangsu Province, 215031, China.
J Cardiothorac Surg. 2025 Jan 6;20(1):29. doi: 10.1186/s13019-024-03301-w.
The impact of pulmonary hypertension (PH) on critically ill patients has not been fully understood. Our objective was to explore the possible relationship between PH and the outcomes in Intensive Care Unit (ICU) patients, and to determine risk factors of in-hospital mortality of ICU PH patients.
The Medical Information Mart for Intensive Care (MIMIC)-IV database was used. Patient characteristics and clinical outcomes of ICU patients with or without PH were compared. The primary outcome was the in-hospital-mortality, and secondary outcome was 28-day mortality. Multivariate logistic regression analysis was conducted to determine independent risk factors of in-hospital mortality.
A total of 42,255 patients were included in the study, of which 1,210 patients had a diagnosis of PH and 4,262 patients died during the hospital stay. In-hospital mortality in the PH and non-PH groups were 15.1% and 9.9% respectively (P < 0.01). The length of stay in ICU and in hospital among ICU PH patients were longer than those without (P < 0.01), and PH group also showed higher 28-day mortality (P < 0.01). Multivariate logistic regression analysis indicated that PH was an independent risk factor for in-hospital mortality in critical ill patients [OR = 1.22, (95%CI: 1.02-1.46), P = 0.033]. Oxford Acute Severity of Illness (OASIS) [OR = 1.10, (95%CI: 1.08-1.12), P < 0.01] anion gap [OR = 1.07, (95%CI: 1.04-1.11), P < 0.01], and Charlson's score [OR = 1.09, (95%CI: 1.03-1.16), P < 0.01] were independent risk factors for in-hospital mortality among ICU PH patients.
PH diangsoed in the ICU setting has unfavorable clinical outcomes. The Bigger the value of OASIS score, anion gap, Charlson's score were the predictors for in-hospital mortality in ICU patients with PH.
肺动脉高压（PH）对重症患者的影响尚未完全明确。我们的目的是探讨PH与重症监护病房（ICU）患者预后之间的可能关系，并确定ICU中PH患者院内死亡的危险因素。
使用重症监护医学信息集市（MIMIC）-IV数据库。比较了有或无PH的ICU患者的特征和临床结局。主要结局是院内死亡率，次要结局是28天死亡率。进行多因素逻辑回归分析以确定院内死亡的独立危险因素。
本研究共纳入42255例患者，其中1210例诊断为PH，4262例在住院期间死亡。PH组和非PH组的院内死亡率分别为15.1%和9.9%（P<0.01）。ICU中PH患者的ICU住院时间和住院时间均长于无PH患者（P<0.01），且PH组的28天死亡率也更高（P<0.01）。多因素逻辑回归分析表明，PH是危重症患者院内死亡的独立危险因素[比值比（OR）=1.22，（95%置信区间：1.02-1.46），P=0.033]。牛津急性疾病严重程度（OASIS）[OR=1.10，（95%置信区间：1.08-1.12），P<0.01]、阴离子间隙[OR=1.07，（95%置信区间：1.04-1.11），P<0.01]和查尔森评分[OR=1.09，（95%置信区间：1.03-1.16），P<0.01]是ICU中PH患者院内死亡的独立危险因素。
在ICU环境中诊断出的PH具有不良临床结局。OASIS评分、阴离子间隙、查尔森评分的值越大，是ICU中PH患者院内死亡的预测因素。
