COVID-19 in Patients with Pulmonary Hypertension: A National Prospective Cohort Study

Abstract

Rationale Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with pulmonary endothelial dysfunction. There are limited data available on the outcomes of coronavirus disease (COVID-19) in patients with pulmonary hypertension (PH), a disease characterized by pulmonary endothelial dysfunction. Objectives To describe characteristics and outcomes of patients with precapillary PH and COVID-19. Methods We prospectively collected characteristics, management, and outcomes of adult patients with precapillary PH in the French PH network who had COVID-19 between February 1, 2020, and April 30, 2021. Clinical, functional, and hemodynamic characteristics of PH before COVID-19 were collected from the French PH registry. Measurements and Main Results A total of 211 patients with PH (including 123 with pulmonary arterial hypertension, 47 with chronic thromboembolic PH, and 41 with other types of PH) experienced COVID-19, and 40.3% of them were outpatients, 32.2% were hospitalized in a conventional ward, and 27.5% were in an ICU. Among hospitalized patients ( n = 126), 54.0% received corticosteroids, 37.3% high-flow oxygen, and 11.1% invasive ventilation. Right ventricular and acute renal failure occurred in 30.2% and 19.8% of patients, respectively. Fifty-two patients (all hospitalized) died from COVID-19. Overall mortality was 24.6% (95% CI [confidence interval], 18.8–30.5) and in-hospital mortality 41.3% (95% CI, 32.7–49.9). Nonsurvivors were significantly older, more frequently male and suffering comorbidities (diabetes, chronic respiratory diseases, systemic hypertension, chronic cardiac diseases, and/or chronic renal failure), and had more severe PH at their most recent evaluation preceding COVID-19 diagnosis (in terms of functional class and 6-minute-walk distance; all P < 0.05). Use of pulmonary arterial hypertension therapy was similar between survivors and nonsurvivors. Conclusions COVID-19 in patients with precapillary PH was associated with a high in-hospital mortality. The typical risk factors for severe COVID-19 and severity of PH were associated with mortality in this population.

Outcomes of COVID-19 in patients vaccinated and unvaccinated against SARS-CoV-2 and suffering from pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension

“…Farmakis et al reported a 3.6% incidence of COVID-19 in PH groups 1 and 4 patients in Greece, which was a little less than that in the general population [20]. Montani et al reported that 2.9% of PH patients with precapillary hypertension in France were diagnosed with COVID-19, a figure higher than the incidence in the general population [11]. While we observed our PAH/CTEPH patients for the 2 years of the pandemic, other authors collected data only in the early months of the pandemic, or before vaccines were rolled out.…”

“…During the first months of the pandemic, there were reports from the United States and Europe of much higher mortality due to COVID-19 in patients with PAH and CTEPH compared to the general population [9,10]. Only one study has examined the impact of PH severity on COVID-19 outcome before vaccination [11]. A high mortality rate may be the consequence of a more severe course of COVID-19 in seriously ill PH patients, although limited diagnostic testing and control visits during the pandemic might have delayed PH diagnosis and early detection of disease progression.…”

Potential long-term effects of SARS-CoV-2 infection on the pulmonary vasculature: Multilayered cross-talks in the setting of coinfections and comorbidities

“…Increased RV afterload can be secondary to pulmonary parenchymal abnormalities during acute infection, combined with macro- or micro-PVD as well as the negative inotropic, prothrombotic, and profibrotic effects of cytokine storm [ 119 – 121 ]. Additionally, patients with RV dysfunction and PH, in particular, experience worse clinical outcomes [ 117 , 122 ].…”

Management of COVID-19 in Patients with Pulmonary Arterial Hypertension

“…The largest study conducted comes from the French PH registry and included 211 patients with pre-capillary PH (among them 58.3% with a diagnosis of PAH) and a diagnosis of COVID-19 from February 2020 to April 2021 ( 9 ). In this prospective cohort, 32.2% of patients were hospitalized in a common ward, while an additional 27.5% of patients were hospitalized in intensive care unit (ICU); the median length of stay was 9 ( 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ) days. High-flow nasal cannula and corticosteroids were increasingly used after September 2020, while the proportion of patients receiving mechanical ventilation (11.1%) was similar between the two first waves of the pandemic.…”