ArticlePloS one2025
Association between pre-existing Pulmonary Hypertension and COVID-19 related outcomes in inpatient and ambulatory care settings.
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAfflicting 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.
methodsWe 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.
resultsPre-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.
conclusionPre-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.
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