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. 2022 Oct 20;11(20):6189.
doi: 10.3390/jcm11206189.

Hospitalisation Is Prognostic of Survival in Chronic Thromboembolic Pulmonary Hypertension

Pavel Jansa  1 , David Ambrož  1 , Michael Aschermann  1 , Vladimír Černý  2 , Vladimír Dytrych  1 , Samuel Heller  1 , Jan Kunstýř  3 , Jaroslav Lindner  4 , Aleš Linhart  1 , Matúš Nižnanský  4 , Michal Paďour  1 , Tomáš Prskavec  4 , Michal Širanec  1 , Susan Edwards  5 , Virginie Gressin  5 , Matyáš Kuhn  6 , Lilla Di Scala  5
Affiliations

Hospitalisation Is Prognostic of Survival in Chronic Thromboembolic Pulmonary Hypertension

Pavel Jansa et al. J Clin Med. .

Erratum in

Abstract

This analysis investigated the prognostic value of hospitalisation in chronic thromboembolic pulmonary hypertension (CTEPH) using data from the Czech Republic, wherein pulmonary endarterectomy (PEA) was the only targeted treatment option until 2015. Using a landmark method, this analysis quantified the association between a first CTEPH-related hospitalisation event occurring before 3-, 6-, 9-, and 12-month landmark timepoints and subsequent all-cause mortality in adult CTEPH patients diagnosed between 2003 and 2016 in the Czech Republic. Patients were stratified into operable and inoperable, according to PEA eligibility. CTEPH-related hospitalisations were defined as non-elective. Hospitalisations related to CTEPH diagnosis, PEA, balloon pulmonary angioplasty, or clinical trial participation were excluded. Of 436 patients who survived to ≥3 months post diagnosis, 309 were operable, and 127 were inoperable. Sex- and age-adjusted hazard ratios (HRs) showed CTEPH-related hospitalisation was a statistically significant prognostic indicator of mortality at 3, 9, and 12 months in inoperable patients, with an approximately 2-fold increased risk of death in the hospitalisation group (HRs [95% CI] ranging from 1.98 [1.06-3.70] to 2.17 [1.01-4.63]). There was also a trend of worse survival probabilities in the hospitalisation groups for operable patients, with the difference most pronounced at 3 months, with a 76% increased risk of death (adjusted HR [95% CI] 1.76 [1.15-2.68]). This first analysis on the prognostic value of CTEPH-related hospitalisations demonstrates that a first CTEPH-related hospitalisation is prognostic of mortality in CTEPH, particularly for inoperable patients. These patients may benefit from medical and/or interventional therapy.

Keywords: CTEPH-related morbidity; hospitalisation; mortality; prognosis; pulmonary endarterectomy; pulmonary hypertension.

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Conflict of interest statement

Pavel Jansa has received fees and grants from Janssen Pharmaceutical Companies of Johnson and Johnson, AOP Orphan, Bayer Healthcare Pharmaceuticals, and MSD. Susan Edwards, Virginie Gressin, and Lilla Di Scala are employees of and have shares in Janssen, a pharmaceutical company of Johnson and Johnson. The remaining authors declare no conflicts of interest. Authors Susan Edwards, Virginie Gressin, and Lilla Di Scala (employees of study funders) had a role in the design of the study, analyses and interpretation of the data, in the writing and reviewing of the manuscript, and in the decision to publish the results.

Figures

Figure 1
Figure 1
Landmark analysis patient disposition for (a) inoperable and (b) operable patients. The number of patients listed as “Died” in each group refers to the status at the data cut-off of 31 December 2018; all patients who did not die by this date were classified as “censored”. Percentages may not total to 100%, as the denominator is number of patients; however, patients may have had more than one hospitalisation. Reasons for hospitalisation are summarised in the final row. HF, heart failure; PE, pulmonary embolism; RF, respiratory failure; VT, venous thromboembolism.
Figure 2
Figure 2
Kaplan–Meier analysis: survival probability at each landmark timepoint (model M1) for (a) inoperable patients and (b) operable patients.
Figure 2
Figure 2
Kaplan–Meier analysis: survival probability at each landmark timepoint (model M1) for (a) inoperable patients and (b) operable patients.
Figure 3
Figure 3
Forest plot showing hazard ratios (HRs) for non-adjusted and adjusted models at landmark timepoints for (a) inoperable patients and (b) operable patients.
See this image and copyright information in PMC

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