title: Thrombocytopenia is an independent predictor of mortality in pulmonary hypertension.
abstract: BACKGROUND
  Established prognostic factors for pulmonary hypertension (PH) include brain natriuretic peptide, troponins and hemodynamic measures such as central venous pressure and cardiac output. The prognostic role of thrombocytopenia, however, has yet to be determined in patients with PH. The aim of this study was to evaluate effect of thrombocytopenia on mortality in patients with PH.
  
  
  METHODS
  521 patients with severe PH, defined by a pulmonary artery systolic pressure >60 mm Hg on transthoracic echocardiography and a platelet count measured within one month after diagnosis were enrolled from three hospitals of Montefiore Medical Center. The cohort was divided into two groups: mild thrombocytopenia to a normal platelet count (platelet count 100,000-450,000 per uL); and moderate to severe thrombocytopenia (platelet count <100,000 per uL). Inpatient and social security death records were used to determine 1-year all-cause mortality.
  
  
  RESULTS
  Mean age was 70.3 ± 15.6 with 40% of patients being male. Overall mortality at 1 year was 30.7%, with increased mortality in PH patients with mild thrombocytopenia compared to those with moderate to severe thrombocytopenia (46.5% vs. 27.0%, p < 0.001). In multivariate analysis, moderate to severe thrombocytopenia remained an independent predictor of mortality (HR 1.798, 95% CI 1.240-2.607, p = 0.002).
  
  
  CONCLUSIONS
  Moderate to severe thrombocytopenia is an independent predictor of higher mortality in patients with severe PH. These findings may support the use of thrombocytopenia as a useful prognostic indicator in patients with severe PH.
authors.affiliation: Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, NY, USA. Electronic address: mkmojadidi@gmail.com.
authors.forename: Mohammad Khalid
authors.initials: MK
authors.lastname: Mojadidi
authors.affiliation: Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: Goodman-Meza
authors.affiliation: Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, NY, USA.
authors.forename: Parham
authors.initials: P
authors.lastname: Eshtehardi
authors.affiliation: Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, NY, USA.
authors.forename: Mohan
authors.initials: M
authors.lastname: Pamerla
authors.affiliation: Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, NY, USA.
authors.forename: Pavlos
authors.initials: P
authors.lastname: Msaouel
authors.affiliation: Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, NY, USA.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Roberts
authors.affiliation: Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, NY, USA.
authors.forename: Jared S
authors.initials: JS
authors.lastname: Winoker
authors.affiliation: Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, NY, USA.
authors.forename: Neville M
authors.initials: NM
authors.lastname: Jadeja
authors.affiliation: Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, NY, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Zolty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010976:Platelet Count; D011379:Prognosis; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000453:epidemiology*
keywords: Mortality; Platelets; Pulmonary hypertension; Thrombocytopenia