Mortality from Pulmonary Hypertension in the Pediatric Cardiac ICU

Area of Science:

• Pediatric Cardiology
• Critical Care Medicine
• Pulmonary Hypertension Research

Background:

• Patients with pulmonary hypertension (PH) admitted to pediatric cardiac intensive care units (CICU) experience elevated mortality rates.
• Identifying factors associated with mortality is crucial for improving outcomes in this high-risk population.

Purpose of the Study:

• To identify independent factors associated with mortality in pediatric patients with PH admitted to cardiac critical care settings.
• To quantify the risk associated with specific interventions and clinical conditions in this patient group.

Main Methods:

• Retrospective analysis of 2,602 admissions with PH to Pediatric Cardiac Critical Care Consortium institutions over five years.
• Multivariable logistic regression was used to determine independent associations with mortality.
• Pulmonary hypertension was defined by diagnosis and/or receipt of intensive care-level pulmonary vasodilator therapy.

Main Results:

• Overall mortality for PH admissions was 10%, compared to 3.9% for other medical admissions.
• Strongest mortality predictors included invasive ventilation (aOR 44.8), noninvasive ventilation (aOR 19.7), cardiopulmonary resuscitation (aOR 8.9), and vasoactive infusions (aOR 4.8).
• Patients requiring both invasive ventilation and vasoactive infusions on admission Days 1-2 had mortality rates around 29%, significantly higher than those not receiving these interventions (<5%).

Conclusions:

• Pediatric patients with PH in cardiac critical care units have a substantial risk of mortality.
• The need for invasive ventilation and vasoactive infusions on early admission days is a critical indicator of severe illness and portends a significantly worse prognosis.
• These findings underscore the severity of illness in PH patients within this setting and can aid in prognostic discussions with families.