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Published online before print February 14, 2007
Eur Respir J 2007, doi:10.1183/09031936.00134506
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ORIGINAL ARTICLE

Prognostic value of blood gas analyses in patients with idiopathic pulmonary arterial hypertension

M.M. Hoeper 1*, M.W. Pletz 1, H. Golpon 1, T. Welte 1

1 Hannover Medical School, Hannover, Germany


  Abstract

Blood gas abnormalities in patients with idiopathic pulmonary arterial hypertension (IPAH) may be related to disease severity and prognosis.

We performed a 12-year, retrospective analysis assessing arterialized capillary blood gases, hemodynamics, exercise variables and survival in 101 patients with IPAH.

At baseline Pa,O2 was 69±14 mmHg and Pa,CO2 was 32±4 mmHg. While Pa,O2 was not associated with survival, a low Pa,CO2 was a strong and independent prognostic marker. When patients were divided according to their baseline Pa,CO2 above or below 32 mmHg, a cut-off value determined by receiver-operating characteristics analysis, survival rates were 98% and 86% at 1 year, 82% and 69% at 2 years, 80% and 51% at 3 years, 77% and 41% at 5 years and 65% and 12% at 8 years (p<0.001 by log rank analysis). Pa,CO2 after 3 months of medical therapy was strongly associated with survival. Hypocapnia at rest and during exercise correlated with low cardiac output, low peak oxygen uptake and reduced ventilatory efficacy. Multiple regression analysis revealed that 6 min walk distance, right atrial pressure, and Pa,CO2 were independently associated with survival.

In patients with IPAH, hypocapnia (Pa,CO2<32 mmHg) is an independent marker of mortality.

Keywords:  Blood gases, carbon dioxide, hyperventilation, hypoxia, pulmonary hypertension




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