Abstract P412: Pulmonary Hypertension in Patients with Preeclampsia: Prevalence, Predictors and Associated In-Hospital Adverse Events

Abstract

Pulmonary hypertension (PH) is prevalent pregnant women, but there is a lack of research into its co-occurence with preeclampsia. Our study aimed to characterize and evaluate the real-world prevalence, predictors and outcomes of PH in preeclamptic patients Data were obtained from the National Inpatient Sample database from 2016 to 2019.Primary outcomes assessed were baseline and hospital admission characteristics and comorbidities for patients with preeclampsia with or without PH, outcomes for preeclamptic patients with PH, and predictors of mortality. Of 255,513 preeclamptic patients, 497 (.194%) developed PH. Patients with PH had a significantly elevated likelihood of having IDA (9.7% vs 2.6%, p<.001), CHF (25.5% vs 0.4%, p<.001), pulmonary disease (17.7% vs 7.6%, p<.001), coagulopathy (2.0% vs 0.8%, p=.002), T2DM (7.2% vs 2.8%, p<.001), hypertension (0.8% vs 0.3%, p=.014), alcohol abuse (1.4% vs 0.1%, p<.001), liver disease (2.0% vs 0.4%, p<.001), atrial fibrillation (0.6% vs 0.1%, p<.001), hypothyroidism (7.0% vs 4.6%, p=.01), CAD (1.8% vs 0.1%, p<.001), OSA (8.7% vs 0.7%, p<.001), opioid use (1.8% vs 0.9%, p=.026), obesity (33.2% vs 19.4%, p<.001), and ESRD (0.8% vs 0.0%, p<.001). Univariate analysis showed that PH in preeclamptic patients was associated with higher rates of cardiac arrest (0.8% vs 0.0% p<.001), permanent pacemaker (1.4% vs 0.1% p<.001), ventricular fibrillation (0.2% vs 0.0% p<.001), angioplasty (0.8% vs 0.0% p<.001), PE (1.0% vs 0.0% p<.001), shock after delivery (1.2% vs 0.1% p<.001), PPH (10.1% vs 7.3% p=.017), right heart catheterization (2.0% vs 0.0% p<.001), left heart catheterization (0.6% vs 0.0% p<.001), cardiogenic shock (1.0% vs 0.0% p<.001), medical ventilation (3.6% vs 0.1% p<.001), vasopressor use (1.2% vs 0.1%, p<.001), STEMI (0.2% vs 0.0%, p<.001), and NSTEMI (1.2% vs 0.0% p<.001). Predictors of mortality included age at admission (OR 1.06, 95% CI 1.0–1.1, p<.05), Asian and Pacific Islander race (OR 4.89, 95% CI 1.9–12.7 p<0.05), CHF (OR 19.41 , 95% CI –, p<.05), coagulopathy (OR 19.4, 95% CI 6.4–58.8 p<.05), liver disease (OR 6.5, 95% CI 2.0–21.3 p<.05), eclampsia (OR 17.3, 95% CI 5.3–55.9 p<.05), and HELLP syndrome (OR 6.2, 95% CI 2.8–13.5 p<.05). PH in preeclampsia is associated with an increased risk of maternal mortality, heart failure, arrhythmia, pulmonary embolism. The present study found age at admission, AAPI race, CHF, coagulopathy, liver disease, eclampsia, and HELLP syndrome to be predictors of mortality.