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Pulmonary hypertension in patients with pulmonary fibrosis awaiting lung transplant

A. F. Shorr, J. L. Wainright, C. S. Cors, C. J. Lettieri, S. D. Nathan
European Respiratory Journal 2007 30: 715-721; DOI: 10.1183/09031936.00107206
A. F. Shorr
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J. L. Wainright
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C. S. Cors
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C. J. Lettieri
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S. D. Nathan
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Tables

  • Table 1—

    Correlates of pulmonary hypertension

    VariableP̄pa <25 mmHgP̄pa ≥25 mmHgP̄pa >40 mmHgp-value#p-value¶
    Subjects n1362932231
    Demographics
     Age yrs54.0±8.753.4±8.549.9±9.20.040<0.0001
     Male60.962.858.70.3600.560
     African-American9.011.819.10.030<0.0001
     BMI kg·m−227.7±4.828.7±5.127.7±5.2<0.00010.870
    Pulmonary function
     FVC % pred49.6±15.748.4±16.751.4±20.80.0200.610
     FEV1 % pred52.7±16.550.0±16.551.5±19.0<0.00010.30
     Pa,CO2 mmHg40.5±5.741.2±6.938.7±7.80.150<0.001
     6-min walk distance <45 m10.313.921.10.010<0.0001
     Any need for O275.986.092.8<0.0001<0.0001
     Any need for ≥3 L·min−1 O237.351.465.4<0.0001<0.0001
     O2 used L·min−12.3±1.92.9±2.13.5±2.4<0.0001<0.0001
    Functional status
     Some or total ADL assistance56.763.374.40.001<0.0001
     Hospitalised3.95.19.70.170<0.0001
     In intensive care unit1.42.34.00.1400.010
    Comorbid illnesses
     COPD12.415.716.20.0300.0130
     Hypertension18.121.622.80.0400.011
     Diabetes10.413.07.50.0600.150
     Corticosteroids60.563.458.40.1700.560
    Haemodynamic monitoring
     Cardiac index L·min−1·m−22.8±0.72.8±0.82.5±0.90.82<0.0001
     Ppcw mmHg8.3±4.212.1±5.514.0±8.2<0.0001<0.0001
    • Data are presented as mean±SD or %, unless otherwise stated. P̄pa: mean pulmonary artery pressure; BMI: body mass index; FVC: forced vital capacity; % pred: % predicted; FEV1: forced expiratory volume in one second; Pa,CO2: carbon dioxide arterial tension; ADL: activities of daily living; COPD: chronic obstructive pulmonary disease; Ppcw: pulmonary capillary wedge pressure. #: P̄pa >25 versus ≤25 mmHg; ¶: P̄pa >40 versus ≤25 mmHg. n = 2,525. 1 kPa = 0.133 mmHg.

  • Table 2—

    Independent correlates of mild-to-moderate pulmonary hypertension#

    VariableAdjusted odds ratio95% CIp-value
    Need for any O21.221.14–1.30<0.001
    Ppcw per 1 mmHg increase above mean value for cohort1.191.16–1.21<0.001
    FEV1 per 1% increase from mean value for cohort0.990.99–1.000.050
    • CI: confidence interval; Ppcw: pulmonary capillary wedge pressure; FEV1: forced expiratory volume in one second. The Hosmer–Lemeshow Goodness-of-Fit test yields a Chi-squared value of 14.8 (p = 0.06). #: defined as mean pulmonary artery pressure between 25–40 mmHg. n = 2,296. 1 kPa = 0.133 mmHg.

  • Table 3—

    Independent correlates of severe pulmonary hypertension#

    VariableAdjusted odds ratio95% CIp-value
    PCO2 per 1-point increase0.920.89–0.960.0001
    Age at listing0.950.92–0.97<0.0001
    FEV1 per 1% increase from mean value for cohort0.960.93–0.990.003
    Ppcw per 1 mmHg increase above mean value for cohort1.221.17–1.28<0.001
    Any O2 needed1.291.12–1.490.004
    O2 need >3 L·min−11.891.03–3.470.041
    African-American1.931.02–3.660.043
    • #: defined as mean pulmonary artery pressure >40 mmHg. CI: confidence interval; PCO2: carbon dioxide tension; FEV1: forced expiratory volume in one second; Ppcw: pulmonary capillary wedge pressure. The Hosmer–Lemeshow Goodness-of-Fit test yields a Chi-squared value of 7.2 (p = 0.51). n = 1,594. 1 kPa = 0.133 mmHg.

  • Table 4—

    Independent correlates of mild-to-moderate isolated pulmonary hypertension

    VariableAdjusted odds ratio95% CIp-value
    FEV1 per 1% increase from mean value for cohort0.990.990–0.9970.006
    Ppcw per 1 mmHg increase above mean value for cohort1.221.18–1.26<0.001
    Need for assistance with ADLs1.241.00–1.540.047
    Hypertension1.331.03–1.720.030
    O2 need >3 L·min−12.842.30–3.50<0.001
    • CI: confidence interval; FEV1: forced expiratory volume in one second; Ppcw: pulmonary capillary wedge pressure; ADLs: activities of daily living. The Hosmer–Lemeshow Goodness-of-Fit test yields a Chi-squared value of 18.1 (p = 0.02). n = 1,883. 1 kPa = 0.133 mmHg.

  • Table 5—

    Independent correlates of severe isolated pulmonary hypertension

    VariableAdjusted odds ratio95% CIp-value
    PCO20.880.85–0.92<0.001
    Age at listing0.940.92–0.96<0.001
    Ppcw per 1 mmHg increase above mean value for cohort1.261.18–1.34<0.001
    6-min walk distance <45 m1.711.00–2.940.050
    Need for assistance with ADLs1.781.15–2.740.010
    African-American1.781.02–3.090.042
    O2 need >3 L·min−14.492.99–6.74<0.001
    • CI: confidence interval; PCO2: carbon dioxide tension; Ppcw: pulmonary capillary wedge pressure; ADLs: activities of daily living. The Hosmer–Lemeshow Goodness-of-Fit test yields a Chi-squared value of 5.9 (p = 0.66). n = 1,308. 1 kPa = 0.133 mmHg.

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Pulmonary hypertension in patients with pulmonary fibrosis awaiting lung transplant
A. F. Shorr, J. L. Wainright, C. S. Cors, C. J. Lettieri, S. D. Nathan
European Respiratory Journal Oct 2007, 30 (4) 715-721; DOI: 10.1183/09031936.00107206

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Pulmonary hypertension in patients with pulmonary fibrosis awaiting lung transplant
A. F. Shorr, J. L. Wainright, C. S. Cors, C. J. Lettieri, S. D. Nathan
European Respiratory Journal Oct 2007, 30 (4) 715-721; DOI: 10.1183/09031936.00107206
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