(1603) Impact of Connective Tissue Disease-Associated Pulmonary Hypertension on Sepsis Hospitalizations

Introduction: Patients with connective tissue disease (CTD) have a significantly higher risk of developing pulmonary hypertension (PH) and tend to have poor outcomes. Data on the effects of CTD-associated PH (CTD-PH) on the underlying hemodynamics and outcomes of patients with sepsis is limited. We sought to investigate the impact of CTD-PH on sepsis hospitalizations and identify which etiology is associated with the highest risk.

Methods: We utilized the National Inpatient Sample 2016–2020 combined database to identify patients with primary and secondary discharge diagnoses (ICD-10 codes) of connective tissue diseases (systemic sclerosis, mixed connective tissue disease, systemic lupus erythematosus, rheumatoid arthritis, and Sjogren’s syndrome), sepsis, and comorbid pulmonary hypertension (combined group 1 and 3 PH). Multivariate logistic regression analysis was used to estimate the effect of PH on outcomes of patients with CTD who had sepsis during their hospitalization, after adjusting for age, gender, race, and relevant comorbidities (diabetes, hypertension, coronary artery disease, congestive heart failure, chronic kidney disease, obesity, COPD, and smoking).

Results: A weighted sample of 133,749 adults with CTD were hospitalized in 2016–2020 with sepsis. Of these, 2029 (1.48%) subjects had combined group 1 and group 3 PH. Subjects with CTD-PH and sepsis had a median age of 60 years, with a female predominance of 85%. Patients with CTD-PH who had sepsis had a prevalence of interstitial lung disease (21%), congestive heart failure (15%), and chronic kidney disease (26%) compared to patients with CTD and sepsis without PH. The odds ratio (OR) of mortality among these subjects was 1.94 times higher (CI: 1.49-2.52) if they had comorbid PH. Additionally, the presence of PH predicted a greater risk of acute heart failure and mortality specific for patients with systemic sclerosis as the CTD etiology (OR 2.04 (C.I: 1.46-2.84, P < 0.001)

Conclusions: Our study shows that PH observed in association with CTD can greatly impact sepsis hospitalizations and is linked with the highest risk of acute heart failure and mortality in patients with systemic sclerosis. Additional studies are necessary using the PH registry to determine the severity of PH and its management in sepsis and other critical illnesses.