美国产妇肺动脉高压与分娩住院期间的心肺功能结果：2016-2020年全国性研究。

IF 2.5 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health Pub Date : 2024-11-18 DOI:10.1016/j.preghy.2024.101170

Paul P. Potnuru , Hayden Jefferies , Roy Lei , Paula Igwe , Yafen Liang

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引用次数: 0

摘要

背景：孕产妇肺动脉高压会带来巨大的发病率和死亡率风险，尤其是在分娩过程中。尽管孕产妇肺动脉高压通常被认为是妊娠禁忌症，但 pH 值管理方面的进步可能有助于改善妊娠结局：在这项全国性研究中，我们旨在描述美国孕产妇肺动脉高压的患病率及其与分娩住院期间不良心肺结局的关联：在这项横断面队列研究中，我们分析了 2016 年至 2020 年全国住院病人样本中的分娩住院情况。主要暴露是产妇肺动脉高压。主要结果是产妇在分娩住院期间发生的心肺发病事件的综合结果，包括：死亡、心力衰竭、术中心力衰竭、肺水肿、心脏骤停、心肌梗死、心室颤动、呼吸衰竭、肺炎、急性肾损伤和心脏转归。在将社会人口学变量和有效临床合并症作为协变量进行调整后，采用倾向评分匹配法估算产妇肺动脉高压与不良心肺结局之间的关系。次要结果包括机械循环支持的使用、住院时间和住院总费用：在18,161,315例分娩住院患者中，有4,630例患者患有肺动脉高压，产妇肺动脉高压患病率为每10万例分娩住院患者中有25例，且患病率呈逐年上升趋势（几率比=1.06，95 % CI 1.01至1.11，P=0.028）。经过倾向评分匹配以创建平衡良好的组别后，4560 名肺动脉高压患者与 4560 名无肺动脉高压患者进行了比较。在这项混杂因素调整分析中，41.1%的肺动脉高压组患者出现了心肺疾病发病率和死亡率这一主要综合结果，而无肺动脉高压组仅为14.4%（调整后的几率比=4.16，95% CI为3.32至5.23，P 结论：在美国，孕产妇肺动脉高压的发病率越来越高，并与不良心肺结局密切相关，41.1%的 pH 值患者在分娩住院期间会出现心肺发病率和死亡率的综合结果。我们的研究结果强调了在高危中心多学科护理产妇肺动脉高压患者的重要性，以确保妥善处理分娩过程中出现的心肺并发症。

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Maternal pulmonary hypertension and cardiopulmonary outcomes during delivery hospitalization in the United States: A nationwide study from 2016–2020

Background

Maternal pulmonary hypertension can pose substantial morbidity and mortality risks, particularly during labor and delivery. Although maternal pulmonary hypertension is conventionally considered a contraindication to pregnancy, advances in the management of pH may contribute to improving outcomes.

Objectives

In this nationwide study, we aim to characterize the prevalence of maternal pulmonary hypertension in the United States and its association with adverse cardiopulmonary outcomes during delivery hospitalizations.

Study Design

In this cross-sectional cohort study, we analyzed delivery hospitalizations in the National Inpatient Sample from 2016 to 2020. The primary exposure was maternal pulmonary hypertension. The primary outcome was a composite of maternal cardiopulmonary morbidity events during the delivery hospitalization including: death, heart failure, intraoperative heart failure, pulmonary edema, cardiac arrest, myocardial infarction, ventricular fibrillation, respiratory failure, pneumonia, acute kidney injury, and cardiac conversion. Propensity score matching was used to estimate the association between maternal pulmonary hypertension and adverse cardiopulmonary outcomes, adjusting for sociodemographic variables and validated clinical comorbidities as covariates. Secondary outcomes included mechanical circulatory support utilization, length of stay, and total hospitalization costs.

Results

Among 18,161,315 delivery hospitalizations, 4,630 patients had pulmonary hypertension, yielding a maternal pulmonary hypertension prevalence of 25 per 100,000 delivery hospitalizations with a yearly trend of increasing prevalence (odds ratio = 1.06, 95 % CI 1.01 to 1.11, P = 0.028). After propensity score matching to create well-balanced groups, 4,560 patients with pulmonary hypertension were compared to 4,560 patients without pulmonary hypertension. In this confounder-adjusted analysis, the primary composite outcome of cardiopulmonary morbidity and mortality occurred in 41.1 % of the PH group compared to 14.4 % in the no PH group (adjusted odds ratio = 4.16, 95 % CI 3.32 to 5.23, P < 0.001). Additionally, patients with PH had a higher incidence of mechanical circulatory support use (adjusted odds ratio = 9.08, 95 % CI 1.14 to 71.81, P = 0.037), longer length of stay (length of stay ratio = 2.82, 95 % CI 2.74 to 2.9, P < 0.001) and higher total hospitalization costs (total cost ratio = 1.67, 95 % CI 1.52 to 1.85, P < 0.001).

Conclusions

Maternal pulmonary hypertension is increasing in prevalence and is strongly associated with adverse cardiopulmonary outcomes in the United States, with 41.1% of pH patients experiencing a composite outcome of cardiopulmonary morbidity and mortality during delivery hospitalization. Our findings emphasize the importance of caring for patients with maternal pulmonary hypertension in a multidisciplinary setting at high-acuity centers to ensure appropriate management of cardiopulmonary complications that arise during labor and delivery.

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来源期刊

Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health OBSTETRICS & GYNECOLOGYPERIPHERAL VASCULAR-PERIPHERAL VASCULAR DISEASE

CiteScore

4.90

自引率

0.00%

发文量

127

期刊介绍： Pregnancy Hypertension: An International Journal of Women''s Cardiovascular Health aims to stimulate research in the field of hypertension in pregnancy, disseminate the useful results of such research, and advance education in the field. We publish articles pertaining to human and animal blood pressure during gestation, hypertension during gestation including physiology of circulatory control, pathophysiology, methodology, therapy or any other material relevant to the relationship between elevated blood pressure and pregnancy. The subtitle reflects the wider aspects of studying hypertension in pregnancy thus we also publish articles on in utero programming, nutrition, long term effects of hypertension in pregnancy on cardiovascular health and other research that helps our understanding of the etiology or consequences of hypertension in pregnancy. Case reports are not published unless of exceptional/outstanding importance to the field.