tetano
Editor, Senior Moderator
PLoS One
. 2025 Apr 24;20(4):e0321964.
doi: 10.1371/journal.pone.0321964. eCollection 2025. Association between pre-existing Pulmonary Hypertension and COVID-19 related outcomes in inpatient and ambulatory care settings
Shilpa Vijayakumar[SUP] 1 [/SUP], David W Louis[SUP] 2 [/SUP], Emily Corneau[SUP] 3 [/SUP], Sebhat Erqou[SUP] 3 4 5 [/SUP], Stephen W Waldo[SUP] 6 7 8 [/SUP], Mary E Plomondon[SUP] 6 [/SUP], Madhura Gokhale[SUP] 6 [/SUP], Wasiq Sheikh[SUP] 3 4 5 [/SUP], Phinnara Has[SUP] 9 [/SUP], Saad Marwan[SUP] 4 5 [/SUP], J Dawn Abbott[SUP] 4 5 [/SUP], Matthew Jankowich[SUP] 3 10 [/SUP], Herbert D Aronow[SUP] 11 12 [/SUP], Wen-Chih Wu[SUP] 3 4 5 [/SUP], Gaurav Choudhary[SUP] 3 4 5 [/SUP]
Affiliations
Background: Afflicting up to 1% of population, pulmonary hypertension (PH) is commonly associated with cardiopulmonary and metabolic diseases, but the effect of COVID-19 in patients with pre-existing PH remains unclear.
Methods: We conducted a retrospective cohort study in patients who had undergone right-heart-catheterization within the VA Healthcare system and had a subsequent hospital admission with COVID-19 (inpatient cohort, n=1204) or had COVID-19 positivity but not admitted (outpatient cohort, n=6576). Inpatient findings were confirmed in a non-VA validation cohort (n=656) who had undergone echocardiography with subsequent admission. PH was defined invasively as mean pulmonary artery pressure (mPAP) >20 mmHg and non-invasively as estimated right ventricular systolic pressure (RVSP) >30 mmHg. In-hospital outcomes (inpatient cohort) and 1-year mortality (outpatient cohort) were assessed using multivariable logistic or Cox regression adjusting for confounders.
Results: Pre-existing PH was independently associated with greater in-hospital mortality (PH using mPAP: adjusted odds ratio [aOR] 1.60, 95%CI: 1.04-2.46; PH using RVSP: aOR 2.12, 95% CI 1.18-3.82). Among outpatients, those with COVID-19 had >8-fold higher 90-day and 2.8 fold higher 91-365 day adjusted hazard of mortality irrespective of PH status. Hazards of 90-day hospitalization were similarly driven by COVID-19. The findings were comparable for patient subgroup with normal pulmonary capillary wedge pressures.
Conclusion: Pre-existing PH is independently associated with higher in-hospital COVID-19 mortality. In outpatients, COVID-19 positivity was associated with increased mortality over 1 year irrespective of PH status, with highest risk within the first 90 days.
. 2025 Apr 24;20(4):e0321964.
doi: 10.1371/journal.pone.0321964. eCollection 2025. Association between pre-existing Pulmonary Hypertension and COVID-19 related outcomes in inpatient and ambulatory care settings
Shilpa Vijayakumar[SUP] 1 [/SUP], David W Louis[SUP] 2 [/SUP], Emily Corneau[SUP] 3 [/SUP], Sebhat Erqou[SUP] 3 4 5 [/SUP], Stephen W Waldo[SUP] 6 7 8 [/SUP], Mary E Plomondon[SUP] 6 [/SUP], Madhura Gokhale[SUP] 6 [/SUP], Wasiq Sheikh[SUP] 3 4 5 [/SUP], Phinnara Has[SUP] 9 [/SUP], Saad Marwan[SUP] 4 5 [/SUP], J Dawn Abbott[SUP] 4 5 [/SUP], Matthew Jankowich[SUP] 3 10 [/SUP], Herbert D Aronow[SUP] 11 12 [/SUP], Wen-Chih Wu[SUP] 3 4 5 [/SUP], Gaurav Choudhary[SUP] 3 4 5 [/SUP]
Affiliations
- PMID: 40273140
- PMCID: PMC12021216
- DOI: 10.1371/journal.pone.0321964
Background: Afflicting up to 1% of population, pulmonary hypertension (PH) is commonly associated with cardiopulmonary and metabolic diseases, but the effect of COVID-19 in patients with pre-existing PH remains unclear.
Methods: We conducted a retrospective cohort study in patients who had undergone right-heart-catheterization within the VA Healthcare system and had a subsequent hospital admission with COVID-19 (inpatient cohort, n=1204) or had COVID-19 positivity but not admitted (outpatient cohort, n=6576). Inpatient findings were confirmed in a non-VA validation cohort (n=656) who had undergone echocardiography with subsequent admission. PH was defined invasively as mean pulmonary artery pressure (mPAP) >20 mmHg and non-invasively as estimated right ventricular systolic pressure (RVSP) >30 mmHg. In-hospital outcomes (inpatient cohort) and 1-year mortality (outpatient cohort) were assessed using multivariable logistic or Cox regression adjusting for confounders.
Results: Pre-existing PH was independently associated with greater in-hospital mortality (PH using mPAP: adjusted odds ratio [aOR] 1.60, 95%CI: 1.04-2.46; PH using RVSP: aOR 2.12, 95% CI 1.18-3.82). Among outpatients, those with COVID-19 had >8-fold higher 90-day and 2.8 fold higher 91-365 day adjusted hazard of mortality irrespective of PH status. Hazards of 90-day hospitalization were similarly driven by COVID-19. The findings were comparable for patient subgroup with normal pulmonary capillary wedge pressures.
Conclusion: Pre-existing PH is independently associated with higher in-hospital COVID-19 mortality. In outpatients, COVID-19 positivity was associated with increased mortality over 1 year irrespective of PH status, with highest risk within the first 90 days.