title: Pulmonary Hypertension an Independent Risk Factor for Death in Intensive Care Unit: Correlation of Hemodynamic Factors with Mortality.
abstract: OBJECTIVE
  Critically ill patients with pulmonary hypertension (PH) pose additional challenges due to the existence of right ventricular (RV) dysfunction. The purpose of this study was to assess the impact of hemodynamic factors on the outcome.
  
  
  METHODS
  We reviewed the records of patients with a diagnosis of PH admitted to the intensive care unit. In addition to evaluating traditional hemodynamic parameters, we defined severe PH as right atrial pressure >20 mmHg, mean pulmonary artery pressure >55 mmHg, or cardiac index (CI) <2 L/min/m(2). We also defined the RV functional index (RFI) as pulmonary artery systolic pressure (PASP) adjusted for CI as PASP/CI; increasing values reflect RV dysfunction.
  
  
  RESULTS
  Fifty-three patients (mean age 60 years, 72% women, 79% Blacks), were included in the study. Severe PH was present in 68% of patients who had higher Sequential Organ Failure Assessment (SOFA) score (6.8 ± 3.3 vs 3.8 ± 1.6; P = 0.001) and overall in-hospital mortality (36% vs 6%; P = 0.02) compared to nonsevere patients, although Acute Physiology and Chronic Health Evaluation (APACHE) II scores (19.9 ± 7.5 vs 18.5 ± 6.04; P = 0.52) were similar and sepsis was more frequent among nonsevere PH patients (31 vs 64%; P = 0.02). Severe PH (P = 0.04), lower mean arterial pressure (P = 0.04), and CI (P = 0.01); need for invasive ventilation (P = 0.02) and vasopressors (P = 0.03); and higher SOFA (P = 0.001), APACHE II (P = 0.03), pulmonary vascular resistance index (PVRI) (P = 0.01), and RFI (P = 0.004) were associated with increased mortality. In a multivariate model, SOFA [OR = 1.45, 95% confidence interval (C.I.) = 1.09-1.93; P = 0.01], PVRI (OR = 1.12, 95% C.I. = 1.02-1.24; P = 0.02), and increasing RFI (OR = 1.06, 95% C.I. = 1.01-1.11; P = 0.01) were independently associated with mortality.
  
  
  CONCLUSIONS
  PH is an independent risk factor for mortality in critically ill patients. Composite factors rather than individual hemodynamic parameters are better predictors of outcome. Monitoring of RV function using composite hemodynamic factors resulting in specific interventions is likely to improve survival and needs to be studied further.
authors.affiliation: Division of Pulmonary and Critical care, Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA.
authors.forename: Ghulam
authors.initials: G
authors.lastname: Saydain
authors.affiliation: Division of Pulmonary and Critical care, Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA.
authors.forename: Aamir
authors.initials: A
authors.lastname: Awan
authors.affiliation: Division of Pulmonary and Critical care, Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA.
authors.forename: Palaniappan
authors.initials: P
authors.lastname: Manickam
authors.affiliation: Division of Pulmonary and Critical care, Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Kleinow
authors.affiliation: Division of Pulmonary and Critical care, Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA.
authors.forename: Safwan
authors.initials: S
authors.lastname: Badr
keywords: hemodynamic factors; intensive care unit; lung; mortality; pulmonary hypertension; right ventricular dysfunction