High Rate of Hospitalization, Mortality With COVID-19: Study

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by Steve Bryson, PhD |

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People with pulmonary hypertension (PH) who were diagnosed with COVID-19 had a high rate of hospitalization and in-hospital mortality, a French study concluded.

Risk factors for adverse outcomes included being older, male, having co-existing conditions, or comorbidities, and having more severe PH. Anticoagulants (blood thinners) were the only treatment associated with lower mortality among hospitalized patients.

The study, “COVID-19 in Patients with Pulmonary Hypertension: A National Prospective Cohort Study,” was published in the American Journal of Respiratory and Critical Care Medicine.

SARS-CoV-2, the virus that causes COVID-19, poses an increased risk for poor outcomes in people with PH, a disease marked by increased blood pressure in the blood vessels that supply the lungs, called the pulmonary arteries.

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A team of scientists at several research sites across France followed 211 patients with PH and a diagnosis of COVID-19 to address the lack of data on the impact of COVID-19 on people with PH.

“The aim of this study was to describe the characteristics of PH patients who experienced COVID-19, their management, their outcomes and to identify factors associated with poor outcomes,” the researchers wrote.

The researchers specifically focused on those with precapillary PH, caused by pulmonary vascular remodeling leading to increased resistance to blood flow.

Among the participants, 123 (58.3%) had pulmonary arterial hypertension (PAH), caused by narrowing of the pulmonary arteries, 48 (22.7%) had chronic thromboembolic pulmonary hypertension (CTEPH), caused by chronic blood clots in the lungs, and 40 (19%) had other groups of PH.

Participants ranged in age from 51–71, of whom 54.5% were female. Obesity was a co-existing condition in 52 (24.6%) participants, 82 (38.9%) were former smokers and 16 (7.6%) active smokers.

Other comorbidities included chronic lung disease (35.1%), systemic (body-wide) hypertension (37.9%), diabetes (19.9%), sleep disorders (12.3%), chronic kidney failure (27.5%), immunosuppression in (16.6%), and heart disease (35.1%). Before the COVID-19 diagnosis, 177 (84%) were taking at least one PH therapy, and 116 (55%) were on anticoagulation medication.

Among them, 126 had been hospitalized (59.7%), which lasted between 5–15 days. In the hospital, 68 (54%) received immunosuppressants corticosteroids, 47 (37.3%) required high flow oxygen, 14 (11.1%) needed invasive mechanical ventilation, and two (1.3%) patients had extra-corporeal membrane oxygenation (ECMO), wherein blood is pumped outside the body to a heart-lung machine.

Overall, 52 (24.6%) patients died, which represented 41.3% of those hospitalized. Mortality was 23% among those with PAH, 21.3% in the CTEPH group, and 46.3% in the other groups. All 85 outpatients (40.3%) survived.

Regarding risk factors for in-hospital mortality, those who died were older and more often male. Comorbidities were also more common among deceased participants compared to those who survived. These included chronic respiratory disease (61.5% vs. 26.4%), systemic hypertension (53.8% vs. 32.7%), diabetes (30.8% vs. 16.4%), and chronic kidney failure (51.9% vs. 19.5%).

Before a COVID-19 diagnosis, patients that died had more severe heart disease, less distance walked in six minutes, and a lower DLCO — a measure of the lungs’ ability to transfer oxygen to the red blood cells in pulmonary capillaries.

Additionally, these patients more frequently had higher bloodstream BNP or NTproBNP — markers for heart disease — and elevated blood pressure in the right side of the heart, which pumps blood through the lungs. Patients who received anticoagulation therapy died less frequently.

Higher in-hospital mortality was associated with advanced age, being male, having comorbidities, more severe heart disease, and walking less distance in six minutes. Anticoagulation therapy was related to lower in-hospital mortality. There was no association between PH type and mortality.

A first more complex statistical analysis assessed independent associations between significant demographic factors, heart disease severity, and anticoagulation treatment with in-hospital mortality.

For advanced age, there was a 1.04-time increased risk for in-hospital mortality as well as a 2.46-times increased risk among men. Heart disease severity was not independently associated, whereas there was a trend for the odds of death being lower for those receiving anticoagulation medication.

The second calculation assessed individual comorbidities with in-hospital mortality. Chronic lung disease and chronic kidney failure were independently associated with in-hospital mortality, whereas other heart diseases and systemic hypertension were not. Adding right atrial pressure and elevated BNP/NTproBNP to the calculations did not change these findings.

“Patients with chronic precapillary PH who contract COVID-19 have a high rate of hospitalization and high rate of in-hospital mortality,” the scientists concluded. “Risk factors for adverse outcomes in PH patients with COVID-19 include older age, male sex, comorbidities, and more severe PH.”

“Anticoagulation was the only background treatment associated with lower mortality among hospitalized patients,” they said.