Critical care outcomes in patients with pre-existing pulmonary hypertension: insights from the ASPIRE registry

Abstract

<b>Background:</b> Data on critical care management in patients with pre-existing PH are scarce. <b>Methods:</b> We conducted a retrospective observational study of patients admitted to the critical care unit of a national referral centre between 2000-17. <b>Results:</b> 242 admissions were identified. Hospital survival was 59.3%, 94% and 92% for patients admitted for medical, surgical or obstetric reasons. Medical patients had more severe physiological and laboratory perturbations than surgical or obstetric patients. Higher APACHE II score, age and lactate, and lower SpO₂/FiO₂, platelet count and sodium level were identified as independent predictors of hospital mortality. An exploratory risk score, <b>OPALS</b> (<b>O</b>xygen (SpO₂:FiO₂), ≤185; <b>P</b>latelets, ≤196 x109/L; <b>A</b>ge, ≥37.5 years; <b>L</b>actate, ≥2.45 mmol/L; <b>S</b>odium, ≤130.5 mmol/L), identified medical patients at increasing risk of hospital mortality. The c-statistic (0.78) was comparable with that for APACHE-II (0.74). One of nine patients (11%) who were invasively ventilated for medical decompensation and 50% of patients receiving renal replacement therapy left hospital alive. There was no significant difference in exercise capacity or functional class between follow-up and pre-admission in patients who survived to discharge. <b>Conclusions:</b> These data have clinical utility in guiding critical care management of patients with known PH. The exploratory OPALS score requires validation.