PURPOSE: Patients with Pulmonary Hypertension (PH) and critical illnesses pose a unique challenge in the Medical Intensive Care Unit (MICU). While recommendations regarding management strategies have been addressed in the literature, there is no published data regarding predisposing risk factors associated with MICU admission and poor outcome. Our primary goal is to identify pre admission patient variables that may be associated with the primary outcome of inpatient mortality for PH patients who are admitted to the MICU.
METHODS: Using ICD 9 codes, we retrospectively identified patients with PH not due to left heart disease and at least a 1 day stay in the MICU during the time period 2002-2008. Using a detailed chart review we abstracted data on age, gender, type of PH, and severity of PH. Severity of PH was defined by the World Health Organization functional classification system. Associations between variables were analyzed using the chi-square test.
RESULTS: Forty-three charts for patients with known pulmonary hypertension and a MICU admission were analyzed. Of these patients, 74% were women, and mean age at admission was 52.9 years. Average length of stay in the ICU was 3.8 days and hospital stay was 9.3 days. Sixty-five percent were identified as having Pulmonary Arterial Hypertension, 12% as PH associated with underlying lung diseases, 5% as PH due to thrombotic or embolic disease and in 14% cause was not identified. Of the 43 PH patients admitted to the MICU, there was a 25.6% hospital mortality rate. Mortality did not correlate with gender (p =0.34), type of pulmonary hypertension (p =0.73), or severity of PH ( p=0.43).
CONCLUSION: Based on our patient data set, mortality is not significantly associated with gender, type or severity of PH for patients with PH who are admitted to the MICU. This study is limited by being retrospective and single site.
CLINICAL IMPLICATIONS: Continued research is necessary to identify risk factors that may predispose PH patients to a poor MICU outcome.
DISCLOSURE: Aditi Mathur, No Financial Disclosure Information; No Product/Research Disclosure Information