(1176) In-Hospital Outcomes in Patients With COPD Exacerbation With ASD/PFO and Pulmonary Hypertension

Tuesday, January 23, 2024

8:45 AM – 9:45 AM MT

Location: Connections Central - RST 16

First Author(s)

Yuliana Petryshyn (she/her/hers)

n/a

Co-Author(s)

AD

Aman Dutta, MD

Internal Medicine Resident
Rosalind Franklin University of Medicine and Science, Northwestern Medicine McHenry Hospital, McHenry, IL, United States
AH

Ahmad Harb, MD

Internal Medicine Resident
Rosalind Franklin University of Medicine and Science, Northwestern Medicine McHenry Hospital, McHenry, IL, United States
AS

Abdelraouf Salah, MD

Internal Medicine Resident
Rosalind Franklin University of Medicine and Science, Northwestern Medicine McHenry Hospital, McHenry, IL, United States
AD

Amulya Dwaram, MD

Internal Medicine Resident
Rosalind Franklin University of Medicine and Science, Northwestern Medicine McHenry Hospital, McHenry, IL, United States
BA

Bilal AlKalaji, MD

Internal Medicine Resident
Rosalind Franklin University of Medicine and Science, Northwestern Medicine McHenry Hospital, McHenry, IL, United States
FK

Fahad Khan, MD

Internal Medicine Resident
Rosalind Franklin University of Medicine and Science, Northwestern Medicine McHenry Hospital, McHenry, IL, United States
VG

Vishal Garimella, MD

Internal Medicine Resident
Rosalind Franklin University of Medicine and Science, Northwestern Medicine McHenry Hospital, McHenry, IL, United States
OF

Omar Fakhoury, MD

Internal Medicine Resident
Rosalind Franklin University of Medicine and Science, Northwestern Medicine McHenry Hospital, McHenry, IL, United States

Introduction: Patients with chronic obstructive pulmonary disease (COPD) and underlying pulmonary hypertension (PH) have an increased risk of having PFO as a “pop-off valve”. Unrepaired atrial septal defect/patent foramen ovale (ASD/PFO) by itself can cause right-to-left shunting leading to hypoxemia, due to direct flow of deoxygenated blood into systemic circulation. In this study, we sought to determine hospital outcomes for patients admitted with Acute Exacerbation of COPD (AECOPD) with concurrent ASD/PFO and with or without underlying PH.

Methods: We analyzed the National Inpatient Sample database from 2019 using ICD-10 codes. We searched for hospitalized adults with primary diagnosis of Acute Exacerbation of COPD with concurrent ASD/PFO and with or without underlying PH. The primary outcome was in-hospital mortality. The secondary outcomes of interest were also queried by ICD-10 codes.

Results: About 687,490 of patients were admitted for AECOPD with ASD/PFO; 6.86% (47185) had underlying PH. Cohorts with PH vs. no PH had a mean age of 70.59 vs. 67.93; male (37.27% vs. 42.67%) vs. female (62.72% vs. 57.32%); white (70.35% vs. 76.3%) vs. black (20% vs. 13.5%) and Hispanic (4.4% vs. 5.1%). After adjustment for age, sex and race we found that compared to patient without PH, patients admitted for AECOPD with ASD/PFO and co-existing PH had a statistically significant increase in in-hospital mortality (aOR 1.83, CI 1.54-2.71; p<.0001), length of stay (5.02 vs. 3.97; p<.0001), total hospital charge (49,051 vs. 37,310; p<.0001), acute respiratory failure (aOR 1.74, CI 1.67-1.82; p<.0001), increased need for non-invasive (aOR 1.74, CI 1.64-1.85; p<.0001) and invasive (aOR 1.88, CI 1.68-2.11; p<.0001) mechanical ventilation. They also had higher risk for cardiac arrest (aOR 2.49, p<.0001), respiratory arrest (aOR 1.74, p<.0001) and acute kidney injury (aOR 1.55, p<.0001).

Conclusions: Pulmonary hypertension is a significant risk factor that leads to worse outcomes in patients admitted for AECOPD with ASD/PFO.