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

September 29, 2022

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Source/Revelations

disclosures:
Montani reports to the institution that it has received grants or contracts from Acceleron, Janssen and Merck; Acceleron advisory fees; and fees from Bayer, Janssen and Merck. See the study for all relevant financial disclosures from the other authors.


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In a cohort of patients with chronic precapillary pulmonary hypertension, in-hospital death rates for those who contracted COVID-19 were over 40%, according to a study.

research researcher David Montani, MD, PhD, explained that SARS-CoV2 has a penchant for causing pulmonary vascular injury and therefore patients with pre-existing pulmonary vascular disease may be at increased risk of adverse effects from COVID-19. “Conversely, therapies for pulmonary arterial hypertension, which improve pulmonary endothelium function, could protect against SARS-CoV2 effects on the pulmonary endothelium of PAH patients,” Montani, a professor of respiratory medicine at Bicêtre Hospital in Paris, told Healio. “Limited data are available on COVID-19 outcomes in patients with pulmonary hypertension (PH).”

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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 had COVID-19; among them, 40.3% were outpatients, 32.2% were admitted to 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%).

Investigators 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, the non-survivors were older than the survivors (median age, 69.4 years vs. 61.8 years; p <.001) and a higher proportion were men (67.3% vs. 38.4%). Also, more non-survivors versus survivors had comorbidities – including chronic respiratory disease (61.5% versus 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 < .001) - and more severe PH at their most recent evaluation prior to diagnosis of COVID-19.

In addition, the findings showed that the use of PAH therapy was comparable between survivors and non-survivors, although a smaller proportion of deceased patients had received anticoagulant therapy (42.3% vs. 59.1%; p = .03).

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

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