Bauchmuller, K., Condliffe, R., Southern, J. et al. (9 more authors) (2021) Critical care outcomes in patients with pre-existing pulmonary hypertension: insights from the ASPIRE registry. ERJ Open Research, 7 (2). 00046-2021. ISSN 2312-0541
Abstract
Pulmonary Hypertension (PH) is a life-shortening condition characterised by episodes of decompensation precipitated by factors such as disease progression, arrhythmias and sepsis. Surgery and pregnancy also place additional strain on the right ventricle. Data on critical care management in patients with pre-existing PH are scarce.
We conducted a retrospective observational study of a large cohort of patients admitted to the critical care unit of a national referral centre between 2000–17 to establish acute mortality, evaluate predictors of in-hospital mortality and establish longer-term outcomes in survivors to hospital discharge.
242 critical care admissions involving 206 patients were identified. Hospital survival was 59.3%, 94% and 92% for patients admitted for medical, surgical or obstetric reasons. Medical patients had more severe physiological and laboratory perturbations than patients admitted following surgical or obstetric interventions. Higher APACHE II score, age and lactate, and lower SpO2/FiO2, platelet count and sodium level were identified as independent predictors of hospital mortality. An exploratory risk score, OPALS (Oxygen (SpO2:FiO2), ≤185; Platelets, ≤196×109·L−1; Age, ≥37.5 years; Lactate, ≥2.45 mmol·L−1; Sodium, ≤130.5 mmol·L−1), identified medical patients at increasing risk of hospital mortality. One of nine patients (11%) who were invasively ventilated for medical decompensation and 50% of patients receiving renal replacement therapy left hospital alive. There was no significant difference in exercise capacity or functional class between follow-up and pre-admission in patients who survived to discharge.
These data have clinical utility in guiding critical care management of patients with known PH. The exploratory OPALS score requires validation.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © The authors 2021. This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. (http://creativecommons.org/licenses/by-nc/4.0/) |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Sheffield Teaching Hospitals |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 23 Mar 2021 14:11 |
Last Modified: | 13 Apr 2021 16:05 |
Status: | Published |
Publisher: | European Respiratory Society (ERS) |
Refereed: | Yes |
Identification Number: | 10.1183/23120541.00046-2021 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:172403 |