Acute pulmonary hypertension and short-term outcomes in severe Covid-19 patients needing intensive care

Acta Anaesthesiol Scand. 2021 Jul;65(6):761-769. doi: 10.1111/aas.13819. Epub 2021 Mar 27.

Abstract

Introduction: Critically ill Covid-19 pneumonia patients are likely to develop the sequence of acute pulmonary hypertension, right ventricular (RV) strain, and eventually RV failure due to known pathophysiology (endothelial inflammation plus thrombo-embolism) that promotes increased pulmonary vascular resistance and pulmonary artery pressure. This study aimed to investigate the occurrence of acute pulmonary hypertension (aPH) as per established trans-thoracic echocardiography (TTE) criteria in Covid-19 patients receiving intensive care and to explore whether short-term outcomes are affected by the presence of aPH.

Methods: Medical records were reviewed for patients treated in the intensive care units at a tertiary university hospital over a month. The presence of aPH on the TTE was noted, and plasma NTproBNP and troponin were measured as markers of cardiac failure and myocardial injury, respectively. Follow-up data were collected 21 d after the performance of TTE.

Results: In total, 26 of 67 patients (39%) had an assessed systolic pulmonary artery pressure of > 35 mmHg (group aPH), meeting the TTE definition of aPH. NTproBNP levels (median [range]: 1430 [102-30 300] vs. 470 [45-29 600] ng L-1 ; P = .0007), troponin T levels (63 [22-352] vs. 15 [5-407] ng L-1 ; P = .0002), and the 21-d mortality rate (46% vs. 7%; P < .001) were substantially higher in patients with aPH compared to patients not meeting aPH criteria.

Conclusion: TTE-defined acute pulmonary hypertension was frequently observed in severely ill Covid-19 patients. Furthermore, aPH was linked to biomarker-defined myocardial injury and cardiac failure, as well as an almost sevenfold increase in 21-d mortality.

Keywords: Covid-19; echocardiography; intensive care; outcome; prevalence; pulmonary hypertension; tricuspid valve regurgitation.

Publication types

  • Observational Study

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Biomarkers
  • COVID-19 / complications*
  • COVID-19 / mortality
  • COVID-19 / physiopathology
  • COVID-19 / therapy
  • Critical Care*
  • Echocardiography
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Follow-Up Studies
  • Heart Failure / blood
  • Heart Failure / etiology
  • Heart Failure / mortality
  • Hospital Mortality
  • Humans
  • Hypertension, Pulmonary / diagnostic imaging
  • Hypertension, Pulmonary / epidemiology
  • Hypertension, Pulmonary / etiology*
  • Intensive Care Units / statistics & numerical data
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood
  • Peptide Fragments / blood
  • Procedures and Techniques Utilization
  • Respiration, Artificial / statistics & numerical data
  • Retrospective Studies
  • SARS-CoV-2*
  • Sweden
  • Tertiary Care Centers / statistics & numerical data
  • Treatment Outcome
  • Tricuspid Valve Insufficiency / diagnostic imaging
  • Tricuspid Valve Insufficiency / etiology
  • Troponin T / blood

Substances

  • Biomarkers
  • Fibrin Fibrinogen Degradation Products
  • Peptide Fragments
  • Troponin T
  • fibrin fragment D
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain