The prognostic value of pulmonary hypertension in intensive care unit patients from Beth Israel Deaconess Medical Center (BIDMC)

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.