Pulmonary hypertension in cystic fibrosis with advanced lung disease

Don Hayes, Joseph D. Tobias, Heidi M. Mansour, Stephen Kirkby, Karen S. McCoy, Curt J. Daniels, Bryan A. Whitson

Research output: Contribution to journalArticle

37 Scopus citations

Abstract

Rationale: The impact of pulmonary hypertension (PH) on survival in cystic fibrosis (CF) remains unclear. Objectives: To determine the influence of PH on survival in the CF population. Methods: The United Network for Organ Sharing database was queried from 1987 to 2013 to identify first-time lung transplant candidates who were tracked from wait list entry date until death or censoring to determine influence of PH. Using right heart catheterization measurements, mild PH was de fined as mean pulmonary artery pressure greater than or equal to 25 mm Hg and severe greater than or equal to 35 mm Hg. Measurements and Main Results: Of 2,781 CF patients, 2,100 were used for univariate analysis, 764 for Kaplan-Meier survival function, 687 for multivariate Cox models, and 576 and 132 for matching on the propensity of mild PH and severe PH, respectively. Univariate Cox analysis found significant differences in survival for mild PH (hazard ratio [HR], 1.747; 95% confidence interval [CI], 1.387-2.201; P < 0.001) and severe PH (HR, 2.299; 95% CI, 1.639-3.225; P < 0.001). Further assessment by multivariate Cox models identified significant risk for death associated with mild PH (HR, 1.757; 95% CI, 1.367-2.258; P < 0.001) and severe PH (HR, 2.284; 95% CI, 1.596-3.268; P < 0.001). Cox regression stratified on matched pairs of PH cases and control subjects confirmed the risk for death for mild PH (HR, 1.919; 95% CI, 1.290-2.85; P = 0.001) and severe PH (HR, 4.167; 95% CI, 1.709-10.157; P = 0.002). Conclusions: The manifestation of PH is associated with significantly increased risk for death in CF patients with advanced lung disease.

Original languageEnglish (US)
Pages (from-to)898-905
Number of pages8
JournalAmerican journal of respiratory and critical care medicine
Volume190
Issue number8
DOIs
StatePublished - Oct 15 2014

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Keywords

  • Advanced lung disease
  • Cystic fibrosis
  • Pulmonary hypertension
  • Survival

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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