Prognostic Factors for Outcomes in Acute Decompensated Pulmonary Hypertension: Insights from the Prospective ProPULS Study

Le résumé fourni par la source

Managing acute decompensated pulmonary hypertension (PH) is challenging, requiring a multidisciplinary approach. However, prospective data on prognostic factors remain scarce. Aims: The ProPULS study evaluated survival in patients admitted with acute decompensation of pulmonary arterial hypertension (PAH) or chronic thromboembolic PH (CTEPH) and assessed the prognostic value of selected biomarkers. Methods: Multiparmetric data were prospectively collected at admission and on days 3 and 7. The primary endpoint was a composite of death, circulatory support, or emergency transplantation within 90 days of ICU admission. The prognostic significance at any time of selected inflammatory, cardiovascular, and organ damage biomarkers was analyzed. Results: A total of 144 patients (PAH: 90%, CTEPH: 10%, mean age 57±17 years, 56% female) were included. The primary endpoint occurred in 38 patients (26%): 23 deaths, 9 transplantations, and 6 requiring circulatory support. Those experiencing events had lower systemic pressures at admission and worse RV function (TAPSE, TAPSE/SPAP, S wave). Norepinephrine use was associated with a 4.8-fold increased risk of events. Univariate Cox analysis identified multiple biomarkers linked to poor outcomes (GDF15, IL6, TRAIL, FSTL3, Ngal, NT-proBNP, Troponin, Creatinin, Uric acid, ST2, Urea, Na and lactate). In multivariate analysis, IL-6, uric acid, and lactate independently predicted adverse events. Conclusion: Acute decompensated PH carries a high risk of critical events within three months. This study underscores the prognostic value of biomarkers in identifying patients at high risk of refractory RHF, guiding early advanced interventions.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.