Influence of Pulmonary Hypertension on Survival in Advanced Lung Disease

Background: Effects of pulmonary hypertension (PH) in advanced lung disease remain unclear.

Methods: The United Network for Organ Sharing database was queried from 1987 to 2013 to assess survival lung transplant candidates to determine influence of PH in advanced lung disease. Thresholds included mean pulmonary artery pressure ≥25 mmHg (mild PH) and 35 mmHg (severe PH).

Results: Of 12,405 listed possible candidates, 10,158 were used for univariate analysis, 7050 for Kaplan–Meier (KM) function, 6196 for multivariate Cox models, and 5328 (mild PH) and 1910 (severe PH) for propensity score matching (PSM). For mild and severe PH, univariate revealed that PH was associated with survival difference (HR = 1.530, 95 % CI 1.416, 1.654, p < 0.001) and (HR = 2.033, 95 % CI 1.851, 2.232, p < 0.001), respectively. KM function curves demonstrated a significant difference for mild PH (Log-rank test: Chi square (df = 1): 117.76, p < 0.0001) and severe PH (Log-rank test: Chi square (df = 1): 230.91, p < 0.0001). Multivariate Cox models also found a significant increased risk for death for mild PH (HR = 1.750, 95 % CI 1.606, 1.907, p < 0.001) and severe PH (HR = 2.088, 95 % CI 1.879, 2.319, p < 0.001). PSM confirmed this increased risk for death for mild PH (HR = 1.695, 95 % CI 1.502, 1.914, p < 0.001) and severe PH (HR = 1.976, 95 % CI 1.641, 2.379, p < 0.001).

Conclusions: PH is associated with significant increased risk for death in patients with advanced lung disease.