COVID-19 leads to high in-hospital mortality for patients with pulmonary hypertension
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In a cohort of patients with chronic precapillary pulmonary hypertension, the rates of in-hospital mortality for those who contracted COVID-19 were more than 40%, according to a study.
Study investigator David Montani, MD, PhD, explained that SARS-CoV2 has a predilection for causing pulmonary vascular injury and that patients with pre-existing pulmonary vascular disease could therefore be at increased risk for adverse outcomes from COVID-19. “Conversely, pulmonary arterial hypertension therapies, which improve pulmonary endothelial function, could protect from SARS-CoV2 effects on the pulmonary endothelium of PAH patients,” Montani, who is professor of respiratory medicine at the Bicêtre Hospital in Paris, told Healio. “There is limited data available on the outcomes of COVID-19 in patients with pulmonary hypertension (PH).”
For the study, which was published in the American Journal of Respiratory and Critical Care Medicine, Montani and colleagues prospectively collected characteristics, management and outcomes of adults with precapillary PH in the French PH registry. Patients had contracted COVID-19 during the first year of the COVID-19 pandemic.
The study included 211 patients with PH — 123 with PAH, 47 with chronic thromboembolic PH and 41 with other types of PH — who experienced COVID-19; among them, 40.3% were outpatients, 32.2% were hospitalized in a conventional ward and 27.5% were in an ICU.
Treatment for hospitalized patients (n = 126) included corticosteroids (54%), high-flow oxygen (37.3%) and invasive ventilation (11.1%).
Researchers observed an overall mortality of 24.6% (95% CI, 18.8-30.5) and an in-hospital mortality of 41.3% (95% CI, 32.7-49.9). Overall, non-survivors were older than survivors (median age, 69.4 years vs. 61.8 years; P <.001) and a greater proportion were men (67.3% vs. 38.4%). Also, more non-survivors vs. survivors had comorbidities — including chronic respiratory disease (61.5% vs. 26.4%; P < .001) systemic hypertension (53.8% vs. 32.7%; P < .01) diabetes (30.8% vs. 16.4%; P = .02) and chronic renal failure (51.9% vs. 19.5%; P < .001) —and more severe PH at their most recent evaluation preceding COVID-19 diagnosis.
In addition, findings revealed that the use of PAH therapy was comparable between survivors and non-survivors, although a smaller proportion of deceased patients had been receiving anticoagulation therapy (42.3% vs. 59.1%; P = .03).
“This study demonstrates that patients with pulmonary hypertension are at high risk of COVID-19 mortality, illustrating the importance of vaccination, early treatment and other preventative measures in this population,” Montani said.