Heart Failure With Sepsis More Likely in PAH Patients Than Others

Study one of few into how septis, a severe response to infection, affects PAH

Lindsey Shapiro, PhD avatar

by Lindsey Shapiro, PhD |

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People with pulmonary arterial hypertension (PAH) are at a higher risk of acute heart failure when admitted to the hospital for sepsis or septic shock than are patients without PAH, a U.S. study found.

Sepsis — the body’s severe response to infection — in PAH patients, however, was not linked to a greater mortality risk or serious complications like a heart attack or stoke. But these people tended to stay longer in the hospital and accrue more costs than did other sepsis patients.

“The careful in-patient management for patients with PAH, with special consideration to underlying right ventricular [heart] strain is essential to optimize outcomes in acute states, such as sepsis and septic shock,” the researchers wrote.

The study, “Hospital outcomes for patients with pulmonary arterial hypertension in sepsis and septic shock,” was published in the journal BMC Pulmonary Medicine.

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Sepsis is an extreme response to infection that can lead to organ dysfunction. Essentially, the body’s infection fighting mechanisms go into overdrive and turn against the body’s tissues.

If left untreated, sepsis can progress to septic shock, a life-threatening drop in blood pressure.

Hospital stays longer and more costly for PAH patients with sepsis

PAH is marked by a narrowing of the pulmonary arteries, leading to restricted blood flow to the lungs and high blood pressure in those arteries, putting strain on the heart.

Due to these underlying vulnerabilities, PAH patients may be particularly susceptible to complications in response to sepsis. However, “current literature lacks in establishing the impact of PAH in patients with sepsis or septic shock,” the study noted.

Researchers with the University of Kansas evaluated the outcomes of adult PAH patients hospitalized with sepsis between 2016–17, whose data were housed in the Nationwide Readmissions Database (NRD). Data in the NRD represents 58% of all hospitalizations in 28 U.S. states.

Of 2.67 million cases of sepsis or septic shock (subsequently referred to as sepsis), 1,134 cases involved PAH patients. These people had a mean age of 65 and 67% identified as female.

PAH patients with sepsis had a significantly higher prevalence of chronic conditions including pulmonary disease, renal failure, congestive heart failure, coronary artery disease, obesity, and blood clotting disorders than did non-PAH patients. Type 2 diabetes and alcohol abuse were less frequent in these patients.

Using a process called propensity matching, non-PAH and PAH patients were matched in a 2:1 ratio for clinical variables that could influence the study’s findings; five PAH patients lacked sufficient information. The remainder of the study’s analyses involved 1,129 PAH patients and 2,258 non-PAH patients, all hospitalized with sepsis.

The PAH group had a significantly higher rate of acute heart failure compared with the non-PAH group, 24.1% vs. 19.6%.

Other clinical events while hospitalized, including death, an irregular heartbeat, a heart attack, stroke, or kidney injury, did not significantly differ between the groups.

Overall, 16.3% of PAH patients and 15.1% of those without PAH died while in the hospital.

“Our results indicate that patients with PAH do not have a higher risk of worse clinical outcomes when admitted for sepsis or septic shock, except for acute heart failure,” the researchers wrote.

Still, PAH patients had longer hospital stays and higher hospital costs than the non-PAH group. Specifically, people with PAH and sepsis stayed a mean of 13.5 days in the hospital, accruing $164,252 in costs, compared with the non-PAH patients, who stayed a mean of 10.9 days at a cost of $129,185.

According to the researchers, these findings highlight “the importance of investigating effective strategies in the management of PAH, especially in acute illness such as sepsis, to mitigate its burden on the healthcare system.”

“Close follow-up for patients with PAH is an important strategy and has been shown to reduce medical costs,” the team added.

The study’s findings also underscore the need for careful and optimal care of PAH patients with sepsis in order to avoid acute heart failure. This is particularly true in light of previous research demonstrating long-term survival in pulmonary hypertension patients “to be low” after a first hospitalization for acute heart failure, the researchers noted.

“Our results,” the team wrote, “add to the paucity of literature investigating additional hospital outcomes for patients with PAH.”

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