Pulmonary arterial hypertension in critically ill elderly patients.

Objective: To assess the incidence, possible risk factors and prognosis of pulmonary arterial hypertension (PAH) in critically ill elderly patients.

Methods: We selected 122 cases admitted to the ICU, ages 60-93 years old. An echocardiography examination was performed within four days after admission to the ICU. PAH is usually suspected if the patient's pulmonary artery systolic pressure ≥ 40 mmHg. We collected echocardiography data, relevant clinical data and routine laboratory data; we then used a statistical method to analyze the risk factors for PAH in critically ill elderly patients and examined its impact on the prognosis.

Results: Total 51 patients were diagnosed with PAH. The prevalence of critically ill elderly patients with PAH was 41.8%. The ANOVA analysis showed that if patients had COPD ( = 0.031) and/or respiratory failure ( = 0.021), they were more prone to PAH. An enlarged left atrium ( = 0.038) and/or right ventricle ( = 0.029), a declining left ventricle fractional shortening rate ( = 0.038), and an elevated amount of the brain natriuretic peptides ( = 0.046) were all associated with the occurrence of PAH. Multivariate regression analysis showed that the left atrial diameter ( = 0.045) was the risk factor in critically ill elderly patients with PAH. The 30-day mortality rate was 33.3% for elderly patients with PAH, which is statistically significant ( = 0.035) when compared with the mortality rate of patients with normal pulmonary artery pressure. Our multivariate regression analysis also showed that, for critically ill elderly patients admitted in the ICU, PAH ( = 0.039) is risk factor for increased mortality.

Conclusions: A higher incidence of PAH occurs in critically ill elderly patients. PAH is more likely to occur in patients with an enlarged left atrium, and these problems adversely impact the prognosis.