‘Surprising’ Contribution of Pulmonary Hypertension to ARDS Outcomes

HONOLULU — As suspected, patients with acute respiratory distress syndrome (ARDS) had particularly bad outcomes if they had coexisting pulmonary hypertension (PH), an analysis of the National Inpatient Sample showed.

Compared with those with ARDS alone, patients hospitalized with ARDS and PH were more likely to have:

• In-hospital mortality (36.8% vs 24.6%, adjusted OR 1.52, 95% CI 1.46-1.58)
• Longer length of stay (12 vs 10 days, adjusted OR 1.37, 95% CI 1.35-1.38)
• Higher total hospital expenditures ($210,165 vs $160,683)

“One might anticipate that coexisting conditions in critically ill patients like those with ARDS could worsen outcomes. However, the magnitude of the impact that PH had on ARDS patients in our study was indeed surprising,” said Kaushik Kumar, MD, of MedStar Health in Baltimore, at the CHEST annual meeting hosted by the American College of Chest Physicians.

Kumar suggested that clinicians should be vigilant about identifying and managing PH in ARDS patients, as PH remains highly prevalent despite the advances in ARDS management.

Clinicians should be “mindful of RV [right ventricular] failure and acute cor pulmonale, which is the extreme of PH,” he told the audience. “Remember that behind these statistics are individual patients with unique clinical presentations, underscoring the importance of a tailored approach in managing ARDS, especially in the presence of PH.”

ARDS is a condition of acute lung injury characterized by diffuse alveolar damage resulting in hypoxic respiratory failure. The injury may arise due to underlying conditions such as pneumonia, sepsis, or trauma. PH is a recognized consequence of ARDS, occurring due to factors such as pulmonary vasoconstriction, thromboembolism, and interstitial edema, Kumar noted.

His report shows the magnitude of PH correlates with the severity of lung injury in ARDS. “PH could be an indicator of disease severity in ARDS,” he suggested, adding that more research is needed on the efficacy of PH-targeted therapies and the long-term implications of PH in ARDS survivors (e.g., quality of life, long-term morbidity).

This retrospective analysis of hospitalizations with a primary diagnosis of ARDS used the Nationwide Inpatient Sample database spanning records from 2016 to 2018, a period chosen to exclude COVID-19 and coincide with the adoption of ICD-10 codes.

Out of 156,687 adults hospitalized with ARDS, 16.8% had a diagnosis of PH. All were mechanically ventilated.

Compared with patients with ARDS alone, those with coexisting PH were older, more likely to be women, and had more comorbidities.

Kumar acknowledged that the study lacked granular data, such as echocardiographic profiles, right heart catheterization results, and use of respiratory supports. Another limitation of the study was the potential for coding inaccuracies in the source database.

“While further research is needed to explore the potential benefits of PH-targeted therapies and optimal management strategies for patients with ARDS and PH, our study provides important insights into the outcomes of hospitalizations with ARDS and PH and contributes to the growing body of literature on this topic,” Kumar said in a press release.

Future studies should also examine the role of sepsis and right ventricular failure in ARDS and PH, he added.

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