SESSION TITLE: Pulmonary Arterial Hypertension Posters I
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM
PURPOSE: WHO Group III pulmonary hypertension (PHTN) includes patients who have history of chronic obstructive pulmonary disease (COPD) or interstitial lung disease (ILD) and develop PHTN. Hematologic parameters such as red blood cell random distribution width (RDW) have been suggested as a predictor of mortality in patients with PHTN. The effect of other hematological changes has not been well studied in this cohort. We decided to study the hematological profile of Group III PHTN patients diagnosed at our Advanced Lung Disease Clinic.
METHODS: Patients with a diagnosis of ILD or COPD with PHTN (WHO Group III; mean pulmonary artery pressure ≥ 25 mmHg and pulmonary capillary wedge pressure ≤ 15 mmHg) were considered. Demographics, WHO functional class and lab parameters at initial evaluation were obtained from retrospective chart analysis. Data was analyzed using SAS 9.3 (NC, USA). Results were considered significant for alpha<0.05.
RESULTS: There were 38 Group III PHTN patients; 19 with COPD (50.0%), and 19 with ILD (50.0%). Patients with COPD were older at presentation than those with ILD (median 71 years; IQR: 67 - 81 vs 59 years; 50 - 63, p<0.0003 Mann-Whitney Test) and were less likely to be female (47.4% vs 89.5%, p<0.0052 Chi-Squared Test). Patients with COPD were diagnosed at a later stage of disease (WHO FC of III/IV) than ILD patients (89.5% vs 52.6%, p<0.0123). Although COPD patients were more likely to be on home oxygen than ILD patients (66.7% vs. 42.1%) at time of first diagnosis, this difference was not significant. Hematologically, patients with COPD had higher hemoglobin than ILD (15.0g/dL; 12.5 - 16.3 vs 12.5g/dL; 11.4 - 13.5, p<0.0114), and higher hematocrit (46.7%; 38.6 - 50.9 vs. 39.9%; 36.3 - 42.0 p<0.0149). RDW was elevated in both COPD and ILD patients (15.0%; 14.4 - 15.7 and 14.9%; 13.5 - 15.9 respectively); the groups did not differ.
CONCLUSIONS: Results suggest significant hematological changes in patients with Group III PHTN. Patients with COPD and PHTN had worse functional status and greater hypoxemia compared to ILD cohort at initial evaluation. RDW was elevated in both ILD and COPD patients. However, Hb was significantly higher in COPD cohort vs. ILD cohort.
CLINICAL IMPLICATIONS: ILD and COPD PHTN patients, even though grouped together in WHO Group III have different hematologic profiles. Further studies are needed to better understand the pathophysiologic role of these hematologic changes on the clinical course of the disease process.
DISCLOSURE: The following authors have nothing to disclose: Asma Iftikhar, Atul Palkar, Sonu Sahni, Nina Kohn, Arunabh Talwar
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