COVID-19 leads to high in-hospital mortality in patients with pulmonary hypertension

September 29, 2022

2 min reading

Source/Disclosure

Disclosure:
Montani reports that the institution receives grants or contracts from Acceleron, Janssen, and Merck; consulting fees from Acceleron; and honoraria from Bayer, Janssen, and Merck. Please see the study for all the relevant financial data of the other authors.


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In a cohort of patients with chronic precapillary pulmonary hypertension, the in-hospital mortality rate for those who contracted COVID-19 was more than 40%, according to the study.

Examining studies David Montani, MD, PhD, explained that SARS-CoV2 has a propensity to cause pulmonary vascular damage and that patients with pre-existing pulmonary vascular disease could therefore be at increased risk of adverse outcomes from COVID-19. “On the contrary, pulmonary arterial hypertension therapies that improve pulmonary endothelial function could protect against the effects of SARS-CoV2 on the pulmonary endothelium of patients with PAH,” said Healio Montani, who is a professor of respiratory medicine at Bicêtre Hospital in Paris. “There are limited data on the outcomes of COVID-19 in patients with pulmonary hypertension (PH).”

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For a study that was published in American Journal of Respiratory and Critical Care MedicineMontani and colleagues prospectively collected the characteristics, treatment, and outcomes of adults with precapillary PH in the French PH Registry. Patients 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 the classic department and 27.5% in the ICU.

Treatment of hospitalized patients (n = 126) included corticosteroids (54%), high-flow oxygen (37.3%), and invasive ventilation (11.1%).

The 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, nonsurvivors were older than survivors (median age 69.4 years vs. 61.8 years; P < 0.001) and a larger proportion was men (67.3% vs. 38.4%). Also, more nonsurvivors than survivors had comorbidities—including chronic respiratory disease (61.5% vs. 26.4%; P < 0.001) systemic hypertension (53.8% vs. 32.7%; P < 0.01) diabetes (30.8% vs. 16.4%; P = 0.02) and chronic renal failure (51.9% vs. 19.5%; P < 0.001) – and more severe PH at their last assessment before the diagnosis of COVID-19.

In addition, the findings revealed that the use of PAH therapy was comparable between survivors and nonsurvivors, although a smaller proportion of deceased patients received anticoagulant therapy (42.3% vs. 59.1%; P = 0.03).

“This study shows that patients with pulmonary hypertension are at high risk of mortality from COVID-19, illustrating the importance of vaccination, early treatment and other preventive measures in this population,” Montani said.

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