TOPIC: Pulmonary Vascular Disease
TYPE: Original Investigations
PURPOSE: The role of obesity in outcomes of pulmonary hypertension is controversial and data on young obese patients with secondary pulmonary hypertension is sparse. We aimed to assess the demographics, comorbidities, and outcomes of secondary pulmonary hypertension (SPH) in the young obese population using a nationally representative cohort in the United States.
METHODS: We queried the National Inpatient Sample (2017) and used weighted data to identify hospitalizations among young (18-44 years) obese patients with SPH using relevant ICD-10 codes. Patient-level sociodemographic characteristics and pre-existing comorbidities were compared between young obese patients with vs. without SPH. Primary endpoints included all-cause mortality and cardiopulmonary complications. Secondary endpoints included length of stay, patient disposition and hospital charges. A two-tailed p<0.05 was considered statistically significant.
RESULTS: Of 1,090,475 young obese hospitalizations, 17,430 (1.6%) had SPH. Young obese-SPH cohort was often comprised of older (38[33-42]], male (44.7% vs 24%), African American (44.1% vs 24.8%) patients who were hospitalized non-electively (91.8% vs 71.1%) compared to non-SPH cohort. The SPH cohort often consisted of lower income quartile (45.7% vs 35.9%) and urban teaching facility (76.2% vs 72%) admissions compared to non-SPH cohort. SPH cohort was more often associated with rheumatoid arthritis/collagen vascular diseases (3.7% vs 1.5%), congestive heart failure (28.3% vs 2.7%), chronic pulmonary disease (29% vs 14.9%), coagulopathy (7.3% vs 3.1%), hypertension (40.5% vs 27.2%), hyperlipidemia (23.4% vs 11.5%), smoking (39.8% vs 30.2%), uncomplicated diabetes (13.9% vs 8%) and with chronic complications (19.4% vs 8.2%), fluid and electrolyte disorders (35.3% vs 14.5%), chronic kidney disease (17.3% vs 3.6%) and valvular heart diseases (6.6% vs 0.6%) compared to non-SPH cohort. The SPH cohort showed higher odds of all-cause mortality (aOR 1.74, 95% CI 1.54-1.97), cor pulmonale (aOR 12.16, 95% CI 10.90-13.56), pulmonary embolism (aOR 3.76, 95% CI 3.48-4.08), pulmonary hemorrhage (aOR 1.97, 95% CI 1.69-2.29), atrial fibrillation/flutter (aOR 2.59, 95% CI 2.45-2.74), ventricular tachycardia (aOR 4.16, 95% CI 3.83-4.52), ventricular fibrillation/flutter (aOR 2.95, 95% CI 2.40-3.62), supraventricular tachycardia (aOR 2.70, 95% CI 2.42-3.00), cardiac arrest (aOR 1.53, 95% CI 1.29-1.81), cardiogenic shock (aOR 6.92 95% CI 6.13-7.81), compared to non-SPH cohort. The SPH cohort was less often discharged routinely (69.3% vs. 87.8%) and experienced extended hospital stay (5 vs 3 days) and higher hospital charges (45,228$ vs 24,266$) as compared to non-SPH cohort.
CONCLUSIONS: In this nationwide analysis of young obese hospitalizations, cardiovascular comorbidities, all-cause mortality and fatal cardiopulmonary complications were found to be alarmingly higher in the SPH cohort than the non-SPH cohort that subsequently increased healthcare resource utilization and cost.
CLINICAL IMPLICATIONS: Hospitalization in young obese population with SPH demonstrated concerning odds of fatal cardiopulmonary complications and lower survival rate that needs preemptive measures in terms of screening and guidelines for management.
DISCLOSURES: No relevant relationships by Ummul Asfeen, source=Web Response
No relevant relationships by Nilay Bhatt, source=Web Response
No relevant relationships by Mounika Binkam, source=Web Response
No relevant relationships by Rupak Desai, source=Web Response
No relevant relationships by Zainab Gandhi, source=Web Response
No relevant relationships by Jamila Begum Jabar Ali, source=Web Response
No relevant relationships by Sonali Sachdeva, source=Web Response
No relevant relationships by Pablo Tzorin, source=Web Response
No relevant relationships by Ankit Vyas, source=Web Response
No relevant relationships by Nibras Yar Khan, source=Web Response
© 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.