The Impact of COVID-19 Infection on Patients with Severe Chronic Pulmonary Hypertension: A Prospective Study from a Single Referral Center
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Published on: November 18, 2018
Virginija Rudienė1, Lina Kaplerienė1, Monika Laukytė-Slėnienė1
1Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 08661 Vilnius, Lithuania.
Insights
COVID-19 infection had a low overall mortality rate in patients with severe pulmonary hypertension (PH). While lung function remained stable, elevated brain natriuretic peptide (BNP) levels post-infection indicated increased mortality risk.
Area of Science:
- Cardiology
- Pulmonology
- Infectious Diseases
Background:
- COVID-19 poses significant risks to individuals with pre-existing conditions, particularly elderly patients and those with chronic respiratory and cardiovascular diseases like pulmonary hypertension (PH).
- Understanding the impact of COVID-19 on severe chronic PH patients is crucial for managing this vulnerable population.
Purpose of the Study:
- To evaluate the effects of COVID-19 infection on patients diagnosed with severe chronic pulmonary hypertension (PH).
Main Methods:
- A prospective cohort study involving 51 PH patients diagnosed with COVID-19 between November 2020 and December 2022.
- Data collected included clinical presentation, outcomes, brain natriuretic peptide (BNP) levels, pulmonary function tests (DLCO), and CTPA scans.
- Follow-up extended to December 2023.
Main Results:
- The incidence of COVID-19 in the PH cohort was 34%.
- Overall mortality was 15.7%, with 7.8% attributed to COVID-19 complications.
- Higher BNP levels at three months post-COVID-19 correlated with increased mortality (p=0.028).
- Pulmonary function (DLCO) did not significantly decline; pulmonary fibrosis was rare (4.2%).
Conclusions:
- COVID-19 infection in severe chronic PH patients resulted in low overall mortality.
- Pulmonary fibrosis was an infrequent complication.
- COVID-19 may exacerbate chronic heart failure in severe PH patients.
Abstract:
Background and Objectives. COVID-19 infection has a significant burden on global morbidity and mortality, especially in elderly people and in patients with chronic respiratory and cardiovascular diseases, such as pulmonary hypertension (PH). We aimed to evaluate the impact of COVID-19 infection on patients diagnosed with severe chronic PH. Materials and Methods. A single-center prospective cohort study was performed. Patients were enrolled from 1 November 2020 to 31 December 2022. Follow-up was until 31 December 2023. Data were collected on PH diagnosis, clinical presentation, outcomes, brain natriuretic peptide (BNP) levels, pulmonary function test with lung diffusion capacity for carbon monoxide (DLCO), and computed tomography pulmonary angiography (CTPA) analysis. Results. During the 26 months of our study, 51 PH patients were diagnosed with COVID-19 infection. The majority, 44 (86.3%) of all COVID-19 infected patients, were treated on an outpatient basis, and 7 (13.7%) required hospitalization. During the follow-up period, 8 (15.7%) patients died: 4 (7.8%) due to complications of COVID-19 infection, and the other 4 (7.8%) died in the later stages of the follow-up period after recovery from acute COVID-19 infection. Therefore, the in-hospital mortality in our study was 43% (n = 3). As mentioned above, the overall mortality was 7.8% (n = 4). Higher BNP levels in the third month after COVID-19 were associated with higher mortality rates (p = 0.028). Lung function, including DLCO, did not significantly worsen with COVID-19. In our study, 24 patients (47.1%) were referred for a follow-up CTPA scan and one of them developed typical fibrotic lung changes after COVID-19. Conclusions. The incidence of COVID-19 infection in patients diagnosed with PH was 34%. In our patients with severe chronic PH, the overall mortality rate due to COVID-19 infection was low. Pulmonary fibrosis was a rare complication in our cohort. COVID-19 infection in severe PH may increase the risk of worsening chronic heart failure.
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