Survival implications of pulmonary hypertension in end-stage COPD

Abstract

Pulmonary hypertension (PH) is a common finding in chronic obstructive pulmonary disease (COPD) and is associated with poor outcomes. Our objective was to evaluate the survival implications of PH in end-stage COPD. Methods: We performed a retrospective review of adult COPD patients in the Scientific Registry of Transplant Recipients between Jan 2005 and Dec 2014. Patients were classified as: PH absent (mean pulmonary artery pressure (mPAP) Borderline PH, preserved pulmonary vascular resistance (PVR) (mPAP 21-24 mmHg, PVR Borderline PH, high PVR (PVR ≥3 WU) PH, non-elevated PVR (mPAP 25-34 mmHg, PVR PH, high PVR (PVR ≥3 WU) Severe PH (mPAP ≥35 mmHg) Groups were evaluated by log rank test and Cox regression modeling. Patients were censored at transplant. Results: Of 4339 patients, 2287 (53%) had PH, 438 (10%) had severe PH, and 1229 died. Median survival was 4.5y (95% CI 4.1-5y) in group 1, and 2.8y (95% CI 2.5-3.6y) in group 6 (p Conclusions: COPD patients with borderline PH and PH had similarly increased risks of death (regardless of PVR), and those with severe PH had a further increase in risk. These findings are distinct from other lung diseases such as IPF, and suggest the need for a separate ontology for COPD-PH.