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Characteristics and sex differences in bronchopulmonary dysplasia-related pulmonary hypertension
Dansha Zhou1,2, Ting Wang3,4, Yuqin Chen1
1State Key Laboratory of Respiratory Diseases, National Center for Respiratory Medicine, Guangdong Key Laboratory of Vascular Diseases, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, 510120, China.
Insights
This study found sex differences in pediatric pulmonary hypertension (PH) due to bronchopulmonary dysplasia (BPD), with females having higher PH risk and lower survival. Web tools predict BPD-PH risk and survival outcomes.
Area of Science:
- Pediatric Pulmonology
- Neonatology
- Cardiology
Background:
- Pulmonary hypertension (PH) in infants with bronchopulmonary dysplasia (BPD) significantly increases mortality.
- Understanding risk factors for BPD-PH and long-term prognosis is crucial for pediatric BPD management.
Purpose of the Study:
- To identify risk factors for developing PH in pediatric BPD patients.
- To determine factors influencing long-term survival in pediatric BPD.
- To develop predictive tools for BPD-PH risk and patient survival.
Main Methods:
- Analysis of 1082 pediatric BPD patients under three years old.
- Univariate and multivariate regression analyses for risk factor identification.
- Kaplan-Meier survival analysis and risk stratification using predictive scores.
Main Results:
- Severe BPD patients had triple the in-hospital mortality compared to non-severe BPD.
- Pediatric BPD-PH doubled mortality risk compared to BPD without PH.
- Female infants with BPD showed increased BPD-PH likelihood and reduced survival rates.
- Independent risk factors for BPD-PH included female sex, BPD severity, congenital heart defects (VSD, PDA), CDH, uric acid, ALT, and albumin.
- Independent factors for overall survival in pediatric BPD included BPD severity, PH, severe pneumonia, budesonide use, vasopressor use (adrenaline/noradrenaline), ALT, and duration of respiratory support.
- Two web servers were developed for personalized risk prediction of BPD-PH and overall survival in BPD patients.
Conclusions:
- Sex plays a significant role in the development and prognosis of PH in pediatric BPD.
- The developed web servers offer valuable tools for personalized risk assessment and outcome prediction in BPD patients.
Background:
Pulmonary hypertension (PH) secondary to bronchopulmonary dysplasia (BPD) is associated with increased mortality. This study aims to elucidate the risk factors for BPD-PH development and the long-term prognostic factors in pediatric BPD.
Methods:
We analyzed 1082 BPD patients under the age of three. Univariate and multivariate regression were performed to determine the final model. Risk stratification was performed based on the predicted risk score, and Kaplan-Meier survival curves were used to compare survival rates.
Results:
The in-hospital mortality rate of severe BPD was three times than non-severe BPD, and pediatric BPD-PH had twice the mortality compared to BPD without PH. The incidence of BPD was 1.7 times higher in males, but there were no sex-specific differences in BPD severity. However, female children with BPD had a higher likelihood of developing BPD-PH and lower survival rates. Females, severity of BPD, congenital diaphragmatic hernia, ventricular septal defect, patent ductus arteriosus, uric acid, aspartate aminotransferase/alanine transaminase (ALT), and albumin were independent factors of PH in BPD. Severity of BPD, PH, severe pneumonia, budesonide use, use of adrenaline or noradrenaline, ALT, and day of respiratory support were independent factors for overall survival in pediatric BPD. Two web servers were constructed based on these predictive factors for risk prediction of BPD-PH ( https://sex-ph.shinyapps.io/Nomapp1/ ) and overall survival prediction in BPD patients ( https://zds88.shinyapps.io/DynNomapp/ ).
Conclusion:
This study confirmed sex differences in BPD-PH and emphasized the role of sex in the development and prognosis of the disease. Two web servers predicted personalized PH risk and survival outcomes in BPD.
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