Pulmonary hypertension is linked to worse outcomes in hospitalized patients with the acute respiratory distress syndrome
Presenter: Kaushik Kumar, MD, Resident Physician, MedStar Health Internal Medicine, Georgetown University, Baltimore, MD.
Outcomes of hospitalizations with acute respiratory distress syndrome with and without pulmonary hypertension: An analysis from the Nationwide Inpatient Sample. Presented on Oct 10, 2023.
Available at: https://journal.chestnet.org/article/S0012-3692(23)04800-6/fulltext
Among hospitalized patients with the acute respiratory distress syndrome (ARDS), the presence of pulmonary hypertension (PH) is linked to higher mortality, longer length of stay, and increased costs, according to results of this study reported at CHEST 2023. The results suggest that the presence of PH may be a surrogate for disease severity in ARDS patients, said investigator Kaushik Kumar, MD, a resident physician with MedStar Health Internal Medicine, Georgetown University, Baltimore, MD.
“The findings of our study highlight the importance of early identification and management of PH in patients with ARDS, which could potentially reduce mortality rates, shorten hospital stays, and decrease the cost of care,” Dr. Kumar said.
Acute respiratory distress syndrome accounts for approximately 10% of intensive care unit admissions each year in the United States, representing more than 190,000 cases, according to Dr. Kumar. Pulmonary hypertension is a known consequence of ARDS, he added, noting that it frequently coexists in clinical settings, making it important to better understand relationships between the two conditions.
To determine the relationships between PH, ARDS, and outcomes, Dr. Kumar and co-investigators conducted a retrospective analysis of US hospitalizations from 2016 to 2018 in the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample. They identified more than 156,000 patients with ARDS, of whom approximately 26,000 (nearly 17%) had a PH diagnosis. They compared outcomes between patients with ARDS with or without PH, looking specifically at in-hospital mortality, length of stay, and total costs for hospitalization. They used regression models to control for confounders such as age, sex, insurance status, and comorbidities.
Mortality, the primary study outcome, was increased in patients with PH, Dr. Kumar reported. In-hospital mortality rates were 24.6% for ARDS alone and 36.8% for ARDS with PH. He said the odds of death were 52% higher in the ARDS with PH group, based on an adjusted odds ratio (OR) of 1.52 (95% CI, 1.46-1.58; P < .001).
Presence of PH was also associated with longer length of hospital stay and higher costs. Length of stay was 10 days for those with ARDS versus 12 days for those with ARDS and PH (adjusted OR, 1.37; 95% CI, 1.35-1.38; P < .001). Total hospital costs were $160,683 for ARDs alone and $210,165 for ARDS with PH, a mean difference of $19,406 (P < .001).
This study provides important insights into the outcomes of patient hospitalizations with ARDS and PH, according to Dr. Kumar. The takeaway, he added, is that clinicians should be vigilant in identifying PH in patients with ARDS and managing it appropriately.
“Clinicians should be equipped with the knowledge and tools to identify and address PH early on, potentially altering the course of the disease and improving patient outcomes,” he said.
However, the approach to treating PH needs to be individualized. “It’s crucial to remember that behind these statistics are individual patients with unique clinical presentations,” Dr. Kumar explained. Moreover, interdisciplinary collaboration between pulmonologists, cardiologists, and critical care specialists is needed to ensure comprehensive care for these patients.
“As the field progresses, I hope our study acts as a catalyst for further research, fostering a deeper understanding and ultimately better care strategies for those afflicted with ARDS and PH,” Dr. Kumar concluded.
Disclosures
Kaushik Kumar reported no financial disclosures.
References
Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries [published correction appears in JAMA 2016; 316(3):350]. JAMA 2016; 315(8):788-800. doi:10.1001/jama.2016.0291
Kumar K, Jain A, Cifra EM. Outcomes of hospitalizations with acute respiratory distress syndrome with and without pulmonary hypertension: An analysis from the Nationwide Inpatient Sample. Chest 2023; 164(4 Suppl):A5831. doi: https://journal.chestnet.org/article/S0012-3692(23)04800-6/fulltext
Snow RL, Davies P, Pontoppidan H, Zapol WM, Reid L. Pulmonary vascular remodeling in adult respiratory distress syndrome. Am Rev Respir Dis 1982; 126(5):887-892. doi:10.1164/arrd.1982.126.5.887
Whittenberger JL, McGregor M, Berglund E, Borst HG. Influence of state of inflation of the lung on pulmonary vascular resistance. J Appl Physiol 1960; 15:878-882. doi:10.1152/jappl.1960.15.5.878