Characteristics and sex differences in bronchopulmonary dysplasia-related pulmonary hypertension.

Background: Pulmonary hypertension (PH) secondary to bronchopulmonary dysplasia (BPD) is associated with increased mortality. This study aims to elucidate the risk factors for BPD-PH development and the long-term prognostic factors in pediatric BPD.

Methods: We analyzed 1082 BPD patients under the age of three. Univariate and multivariate regression were performed to determine the final model. Risk stratification was performed based on the predicted risk score, and Kaplan-Meier survival curves were used to compare survival rates.

Results: The in-hospital mortality rate of severe BPD was three times than non-severe BPD, and pediatric BPD-PH had twice the mortality compared to BPD without PH. The incidence of BPD was 1.7 times higher in males, but there were no sex-specific differences in BPD severity. However, female children with BPD had a higher likelihood of developing BPD-PH and lower survival rates. Females, severity of BPD, congenital diaphragmatic hernia, ventricular septal defect, patent ductus arteriosus, uric acid, aspartate aminotransferase/alanine transaminase (ALT), and albumin were independent factors of PH in BPD. Severity of BPD, PH, severe pneumonia, budesonide use, use of adrenaline or noradrenaline, ALT, and day of respiratory support were independent factors for overall survival in pediatric BPD. Two web servers were constructed based on these predictive factors for risk prediction of BPD-PH ( https://sex-ph.shinyapps.io/Nomapp1/ ) and overall survival prediction in BPD patients ( https://zds88.shinyapps.io/DynNomapp/ ).

Conclusion: This study confirmed sex differences in BPD-PH and emphasized the role of sex in the development and prognosis of the disease. Two web servers predicted personalized PH risk and survival outcomes in BPD.