Prognosis and its risk factors of patients with acute decompensated pulmonary hypertension in emergency intensive care unit
Objective To discuss the prognosis and its risk factors in patients with acute decompensatory pulmonary hypertension and provide a basis for their clinical management.Methods A total of 287 patients with acute decompensated pulmonary hypertension patients were selected in our hospital's Emergency Intensive Care Unit between April 2015 and April 2020.Patients were divided into a survival group(n=140)and a death group(n=147)according to in-hospital mortality status.The clinical characteristics,laboratory examination results,treatment plans,clinical events,and prognoses were compared between groups.The correlation between the in-hospital mortality rate,Euro-pean Society of Cardiology/European Respiratory Society(ESC/ERS)risk assessment system score,and Sequential Organ Failure Assessment(SOFA)score were evaluated using multivariate regression analysis.The ESC/ERS risk assessment system and SOFA scores were analyzed to evaluate the efficiency of clinical prognosis using a receiver operating characteristic(ROC)curve.Results Compared with the survival group,in the death group,the rates of intermediate and high risk in the ESC/ERS assessment and NYHAⅢ/Ⅳclass were increased(P<0.05),the mean pulmonary artery pressure and N-terminal pro-BNP(NT-proBNP)level were considerably elevated(P<0.05),and the levels of arte-rial partial pressure of oxygen(PaO2)and tricuspid annular plane systolic extrusion were considerably reduced(P<0.05).On a multivariate Cox regression analysis,a SOFA score≥8,high ESC/ERS risk assessment score,and high NT-proBNP and PaO2 levels were independent risk factors for in-hospital mortality(all P<0.05).A ROC curve analysis showed that the area under the curve of the ESC/ERS risk assessment combined with SOFA score was the largest at 0.877(P<0.001),with a sensitivity of 92.5%and specificity of 83.0%.Conclusion High risk on an ESC/ERS risk assessment and a SOFA score≥8 are independent risk factors of in-hospital mortality among patients with acute decom-pensatory pulmonary hypertension.The ESC/ERS risk assessment and SOFA score can be used to evaluate the prognosis of patients with acute decompensated pulmonary hypertension in the Intensive Care Unit;moreover,their combined use has better predictive efficacy.
acute decompensated pulmonary hypertensionemergency intensive care unitprognosisrisk factor
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