title: Outcomes of hospitalisation for right heart failure in pulmonary arterial hypertension.
abstract: The aim of this study was to examine the causes and outcomes of hospitalisation in patients with pulmonary arterial hypertension (PAH). 205 consecutive hospitalisations occurring between 2000 and 2009 in 90 PAH patients were studied. The leading causes for hospitalisation were right heart failure (RHF; 56%), infection (16%) and bleeding disorders (8%). For patients with RHF, in-hospital mortality was 14% overall, 46% for patients receiving inotropes and 48% for those admitted to the intensive care unit. The predictors for in-hospital mortality were the presence of connective tissue disease (CTD) (OR 4.92), systolic blood pressure <100 mmHg (OR 4.32) and Na ≤ 136 mEq · L(-1) (OR 4.29). Mortality after discharge was 13, 26 and 35% at 3, 6 and 12 months, respectively. World Health Organization functional class prior to admission, renal dysfunction, Charlson comorbidity index, and the presence of CTD were all predictors of mortality after discharge. Hyponatraemia and low systolic blood pressure upon admission and underlying CTD are the main prognostic factors for in-hospital mortality in patients with PAH admitted for RHF. The short-term outcomes after discharge are poor and remarkably worse in patients with underlying CTD or renal impairment. Early recognition of these factors may guide decisions regarding more aggressive therapy, including consideration for lung transplantation.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E Monument St, Baltimore, MD 21205, USA.
authors.forename: A
authors.initials: A
authors.lastname: Campo
authors.forename: S C
authors.initials: SC
authors.lastname: Mathai
authors.forename: J
authors.initials: J
authors.lastname: Le Pavec
authors.forename: A L
authors.initials: AL
authors.lastname: Zaiman
authors.forename: L K
authors.initials: LK
authors.lastname: Hummers
authors.forename: D
authors.initials: D
authors.lastname: Boyce
authors.forename: T
authors.initials: T
authors.lastname: Housten
authors.forename: N
authors.initials: N
authors.lastname: Lechtzin
authors.forename: H
authors.initials: H
authors.lastname: Chami
authors.forename: R E
authors.initials: RE
authors.lastname: Girgis
authors.forename: P M
authors.initials: PM
authors.lastname: Hassoun
mesh_terms: D000328:Adult; D000368:Aged; D001778:Blood Coagulation Disorders / Q000453:epidemiology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003240:Connective Tissue Diseases / Q000453:epidemiology; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality*; D007010:Hyponatremia / Q000453:epidemiology; D007022:Hypotension / Q000453:epidemiology; D007239:Infections / Q000453:epidemiology; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents