Systolic Pulmonary Artery Pressure as Long-Term Mortality Predictor in Elderly Critically Ill with Severe COVID-19 Pneumonia

DOI record: { "DOI": "10.3390/v17020244", "ISSN": [ "1999-4915" ], "URL": "http://dx.doi.org/10.3390/v17020244", "abstract": "<jats:p>Background: COVID-19 can cause acute pulmonary hypertension (PH), worsening outcomes in critically ill elderly patients. Point-of-care ultrasound (POCUS), assessing right ventricular hemodynamics, predicts short-term outcomes. This study examines the long-term impact of acute PH on mortality in elderly COVID-19 patients. Methods: This retrospective long-term study analyzed data from patients over 70 years old with severe COVID-19 pneumonia admitted to a mixed 25-bed, level 3 intensive care unit (ICU). POCUS focused on systolic pulmonary artery pressure (sPAP) at admission. Mortality was evaluated 1000 days post-admission. Results: The study included 130 patients, comprising 30 long-term survivors and 100 non-survivors, with a cumulative long-term mortality rate of 77%. Non-survivors had significantly higher sPAP values (39.1 ± 12.8 vs. 30.4 ± 9.2, p = 0.04), which were associated with long-term mortality in survival analysis. Conclusion: Acute pulmonary hypertension (PH), reflected by elevated systolic pulmonary artery pressure (sPAP), is strongly associated with long-term mortality in elderly critically ill COVID-19 patients. Early assessment of sPAP via POCUS may help identify high-risk patients and guide management strategies to improve outcomes.</jats:p>", "alternative-id": [ "v17020244" ], "author": [ { "ORCID": "https://orcid.org/0000-0002-9433-2035", "affiliation": [ { "name": "Department of Internal Intensive Medicine, General Hospital Celje, 3000 Celje, Slovenia" } ], "authenticated-orcid": false, "family": "Kurnik", "given": "Marko", "sequence": "first" }, { "affiliation": [ { "name": "Department of Internal Intensive Medicine, General Hospital Celje, 3000 Celje, Slovenia" } ], "family": "Božič", "given": "Helena", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Internal Intensive Medicine, General Hospital Celje, 3000 Celje, Slovenia" }, { "name": "Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia" } ], "family": "Podbregar", "given": "Matej", "sequence": "additional" } ], "container-title": "Viruses", "container-title-short": "Viruses", "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2025, 2, 11 ] ], "date-time": "2025-02-11T14:36:05Z", "timestamp": 1739284565000 }, "deposited": { "date-parts": [ [ 2025, 2, 13 ] ], "date-time": "2025-02-13T05:50:41Z", "timestamp": 1739425841000 }, "indexed": { "date-parts": [ [ 2025, 2, 13 ] ], "date-time": "2025-02-13T06:10:15Z", "timestamp": 1739427015218, "version": "3.37.0" }, "is-referenced-by-count": 0, "issue": "2", "issued": { "date-parts": [ [ 2025, 2, 11 ] ] }, "journal-issue": { "issue": "2", "published-online": { "date-parts": [ [ 2025, 2 ] ] } }, "language": "en", "license": [ { "URL": "https://creativecommons.org/licenses/by/4.0/", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2025, 2, 11 ] ], "date-time": "2025-02-11T00:00:00Z", "timestamp": 1739232000000 } } ], "link": [ { "URL": "https://www.mdpi.com/1999-4915/17/2/244/pdf", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "1968", "original-title": [], "page": "244", "prefix": "10.3390", "published": { "date-parts": [ [ 2025, 2, 11 ] ] }, "published-online": { "date-parts": [ [ 2025, 2, 11 ] ] }, "publisher": "MDPI AG", "reference": [ { "DOI": "10.1016/S0140-6736(20)30183-5", "article-title": "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China", "author": "Huang", "doi-asserted-by": "crossref", "first-page": "497", "journal-title": "Lancet", "key": "ref_1", "volume": "395", "year": "2020" }, { "DOI": "10.1183/13993003.01913-2018", "article-title": "Haemodynamic definitions and updated clinical classification of pulmonary hypertension", "author": "Simonneau", "doi-asserted-by": "crossref", "first-page": "1801913", "journal-title": "Eur. Respir. J.", "key": "ref_2", "volume": "53", "year": "2019" }, { "DOI": "10.1093/eurheartj/ehac237", "article-title": "2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension", "author": "Humbert", "doi-asserted-by": "crossref", "first-page": "3618", "journal-title": "Eur. Heart J.", "key": "ref_3", "volume": "43", "year": "2022" }, { "DOI": "10.1111/j.1755-5922.2009.00095.x", "article-title": "The management of acute pulmonary arterial hypertension", "doi-asserted-by": "crossref", "first-page": "153", "journal-title": "Cardiovasc. Ther.", "key": "ref_4", "volume": "29", "year": "2011" }, { "DOI": "10.1186/s12947-023-00300-0", "article-title": "Pulmonary hypertension at admission predicts ICU mortality in elderly critically ill with severe COVID-19 pneumonia: Retrospective cohort study", "author": "Kurnik", "doi-asserted-by": "crossref", "first-page": "1", "journal-title": "Cardiovasc. Ultrasound", "key": "ref_5", "volume": "21", "year": "2023" }, { "DOI": "10.1016/j.cpcardiol.2021.101004", "article-title": "Severe Pulmonary Hypertension: An Important Sequel After Severe Post-Acute COVID-19 Pneumonia", "author": "Rojas", "doi-asserted-by": "crossref", "first-page": "101004", "journal-title": "Curr. Probl. Cardiol.", "key": "ref_6", "volume": "47", "year": "2022" }, { "DOI": "10.20944/preprints202102.0319.v2", "doi-asserted-by": "crossref", "key": "ref_7", "unstructured": "Alves, V.P., Casemiro, F.G., Araujo, B.G., Lima, M.A.S., Oliveira, R.S., Fernandes, F.T.S., Gomes, A.V.C., and Gregori, D. (2021). Factors Associated with Mortality among Elderly People in the COVID-19 Pandemic (SARS-CoV-2): A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health, 18." }, { "DOI": "10.1111/echo.14837", "article-title": "Critical care ultrasonography during COVID-19 pandemic: The ORACLE protocol", "doi-asserted-by": "crossref", "first-page": "1353", "journal-title": "Echocardiography", "key": "ref_8", "volume": "37", "year": "2020" }, { "DOI": "10.1016/j.hlc.2024.01.036", "article-title": "The Effect of Pulmonary Hypertension on Mortality and Intensive Care Unit Admission in Patients With SARS-CoV-2 Infection: A Systematic Review and Meta-Analysis", "author": "Papageorgiou", "doi-asserted-by": "crossref", "first-page": "1136", "journal-title": "Heart Lung Circ.", "key": "ref_9", "volume": "33", "year": "2024" }, { "DOI": "10.1161/CIR.0000000000000560", "article-title": "Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association", "author": "Konstam", "doi-asserted-by": "crossref", "first-page": "e578", "journal-title": "Circulation", "key": "ref_10", "volume": "137", "year": "2018" }, { "DOI": "10.1016/j.resinv.2023.10.001", "article-title": "Outcomes of patients with elevated pulmonary artery systolic pressure on echocardiography due to chronic lung diseases", "author": "Salahuddin", "doi-asserted-by": "crossref", "first-page": "69", "journal-title": "Respir. Investig.", "key": "ref_11", "volume": "62", "year": "2024" }, { "DOI": "10.1067/mje.2000.104535", "article-title": "Doppler-determined peak systolic tricuspid pressure gradient in persons with normal pulmonary function and tricuspid regurgitation", "author": "Aessopos", "doi-asserted-by": "crossref", "first-page": "645", "journal-title": "J. Am. Soc. Echocardiogr.", "key": "ref_12", "volume": "13", "year": "2000" }, { "DOI": "10.1080/14787210.2020.1808462", "article-title": "MATH+ protocol for the treatment of SARS-CoV-2 infection: The scientific rationale", "author": "Marik", "doi-asserted-by": "crossref", "first-page": "129", "journal-title": "Expert Rev. Anti. Infect. Ther.", "key": "ref_13", "volume": "19", "year": "2021" }, { "DOI": "10.1016/j.jcrc.2016.05.022", "article-title": "Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: The utility of the ROX index", "author": "Roca", "doi-asserted-by": "crossref", "first-page": "200", "journal-title": "J. Crit. Care", "key": "ref_14", "volume": "35", "year": "2016" }, { "DOI": "10.1177/20503121231187755", "article-title": "Pulmonary hypertension predicts higher mortality in patients admitted with severe COVID-19 infection", "author": "Minkin", "doi-asserted-by": "crossref", "first-page": "20503121231187755", "journal-title": "SAGE Open Med.", "key": "ref_15", "volume": "11", "year": "2023" }, { "DOI": "10.1186/s13613-014-0028-6", "article-title": "Pulmonary vascular dysfunction in ARDS", "author": "Ryan", "doi-asserted-by": "crossref", "first-page": "28", "journal-title": "Ann. Intensive Care", "key": "ref_16", "volume": "4", "year": "2014" }, { "DOI": "10.1111/echo.15351", "article-title": "The role of expert focus echocardiography during the COVID-19 pandemic", "author": "McPhail", "doi-asserted-by": "crossref", "first-page": "701", "journal-title": "Echocardiography", "key": "ref_17", "volume": "39", "year": "2022" }, { "DOI": "10.5772/67151", "doi-asserted-by": "crossref", "key": "ref_18", "unstructured": "Charolidi, N., and Carroll, V.A. (2017). Hypoxia and Pulmonary Hypertension. Hypoxia and Human Diseases, InTech." }, { "DOI": "10.1016/j.amjcard.2023.05.035", "article-title": "Pulmonary Hypertension in Pulmonary Embolism", "author": "Arrigo", "doi-asserted-by": "crossref", "first-page": "249", "journal-title": "Am. J. Cardiol.", "key": "ref_19", "volume": "200", "year": "2023" }, { "DOI": "10.1161/01.CIR.49.1.152", "article-title": "Experimental pulmonary embolism; effect on pulmonary blood volume and vascular compliance", "author": "Alpert", "doi-asserted-by": "crossref", "first-page": "152", "journal-title": "Circulation", "key": "ref_20", "volume": "49", "year": "1974" }, { "DOI": "10.1038/s41598-020-77641-7", "doi-asserted-by": "crossref", "key": "ref_21", "unstructured": "Trecarichi, E.M., Mazzitelli, M., Serapide, F., Pelle, M.C., Tassone, B., Arrighi, E., Perri, G., Fusco, P., Scaglione, V., and Davoli, C. (2020). Clinical characteristics and predictors of mortality associated with COVID-19 in elderly patients from a long-term care facility. Sci. Rep., 10." }, { "DOI": "10.1371/journal.pone.0293883", "doi-asserted-by": "crossref", "key": "ref_22", "unstructured": "Santos, M.M.S., Pereira, I.J., Cuboia, N., Reis-Pardal, J., Adriao, D., Cardoso, T., Aragao, I., Santos, L., Sarmento, A., and Rosa, R.G. (2023). Predictors of early and long-term mortality after ICU discharge in critically ill COVID-19 patients: A prospective cohort study. PLoS ONE, 18." }, { "article-title": "Short- and long-term survival of patients hospitalized for COVID-19 in relation to cardiovascular risk factors and established cardiovascular disease: The Cor-Cardio study", "author": "Ostrowska", "first-page": "16441", "journal-title": "Pol. Arch. Intern. Med.", "key": "ref_23", "volume": "133", "year": "2023" }, { "key": "ref_24", "unstructured": "ARDS Definition of Task Force, Ranieri, V.M., Rubenfeld, G.D., Thompson, B.T., Ferguson, N.D., Caldwell, E., Fan, E., Camporota, L., and Slutsky, A.S. (2012). Acute respiratory distress syndrome: The Berlin Definition. JAMA, 307, 2526–2533." }, { "DOI": "10.1038/s41598-022-18991-2", "doi-asserted-by": "crossref", "key": "ref_25", "unstructured": "Benes, J., Jankowski, M., Szuldrzynski, K., Zahorec, R., Lainscak, M., Ruszkai, Z., Podbregar, M., Zatloukal, J., Kletecka, J., and Kusza, K. (2022). SepsEast Registry indicates high mortality associated with COVID-19 caused acute respiratory failure in Central-Eastern European intensive care units. Sci. Rep., 12." }, { "DOI": "10.3390/medicina57101070", "doi-asserted-by": "crossref", "key": "ref_26", "unstructured": "Feng, T., James, A., Doumlele, K., White, S., Twardzik, W., Zahid, K., Sattar, Z., Ukponmwan, O., Nakeshbandi, M., and Chow, L. (2021). Procalcitonin Levels in COVID-19 Patients Are Strongly Associated with Mortality and ICU Acceptance in an Underserved, Inner City Population. Medicina, 57." }, { "DOI": "10.1101/2020.04.08.20056598", "doi-asserted-by": "crossref", "key": "ref_27", "unstructured": "Izcovich, A., Ragusa, M.A., Tortosa, F., Lavena Marzio, M.A., Agnoletti, C., Bengolea, A., Ceirano, A., Espinosa, F., Saavedra, E., and Sanguine, V. (2020). Prognostic factors for severity and mortality in patients infected with COVID-19: A systematic review. PLoS ONE, 15." }, { "DOI": "10.3947/ic.2019.51.3.263", "article-title": "Prognostic Value of Serum Procalcitonin level for the Diagnosis of Bacterial Infections in Critically-ill Patients", "author": "Leelasupasri", "doi-asserted-by": "crossref", "first-page": "263", "journal-title": "Infect. Chemother.", "key": "ref_28", "volume": "51", "year": "2019" }, { "article-title": "Long-Term Survival Following Sepsis", "author": "Schmidt", "first-page": "775", "journal-title": "Dtsch. Arztebl. Int.", "key": "ref_29", "volume": "117", "year": "2020" }, { "DOI": "10.1183/13993003.01426-2022", "article-title": "Effects of intubation timing in patients with COVID-19 throughout the four waves of the pandemic: A matched analysis", "author": "Riera", "doi-asserted-by": "crossref", "first-page": "2201426", "journal-title": "Eur. Respir. J.", "key": "ref_30", "volume": "61", "year": "2023" }, { "DOI": "10.7150/ijms.50039", "article-title": "Risk factors for mortality of critically ill patients with COVID-19 receiving invasive ventilation", "author": "Tu", "doi-asserted-by": "crossref", "first-page": "1198", "journal-title": "Int. J. Med. Sci.", "key": "ref_31", "volume": "18", "year": "2021" }, { "DOI": "10.1186/2110-5820-1-6", "article-title": "Septic cardiomyopathy", "doi-asserted-by": "crossref", "first-page": "6", "journal-title": "Ann. Intensive Care", "key": "ref_32", "volume": "1", "year": "2011" }, { "article-title": "Prognostic value of lung ultrasound score performed in the Emergency Department in COVID-19 patients: A prospective multicenter study in central Italy", "author": "Barbieri", "first-page": "12268", "journal-title": "Emerg. Care J.", "key": "ref_33", "volume": "20", "year": "2024" }, { "DOI": "10.1164/rccm.201002-0250OC", "article-title": "Pulmonary vascular dysfunction is associated with poor outcomes in patients with acute lung injury", "author": "Bull", "doi-asserted-by": "crossref", "first-page": "1123", "journal-title": "Am. J. Respir. Crit. Care Med.", "key": "ref_34", "volume": "182", "year": "2010" }, { "DOI": "10.1056/NEJM197703032960903", "article-title": "Pulmonary hypertension in severe acute respiratory failure", "author": "Zapol", "doi-asserted-by": "crossref", "first-page": "476", "journal-title": "N. Engl. J. Med.", "key": "ref_35", "volume": "296", "year": "1977" }, { "DOI": "10.1177/2045893217753415", "article-title": "Hemodynamic profile of pulmonary hypertension (PH) in ARDS", "author": "Calcaianu", "doi-asserted-by": "crossref", "first-page": "2045893217753415", "journal-title": "Pulm. Circ.", "key": "ref_36", "volume": "8", "year": "2018" }, { "DOI": "10.1007/s00134-008-1307-1", "article-title": "Incidence and prognostic value of right ventricular failure in acute respiratory distress syndrome", "author": "Osman", "doi-asserted-by": "crossref", "first-page": "69", "journal-title": "Intensive Care Med.", "key": "ref_37", "volume": "35", "year": "2009" }, { "DOI": "10.1016/j.chest.2023.07.3762", "article-title": "Outcomes of Hospitalizations with Acute Respiratory Distress Syndrome with and without Pulmonary Hypertension: An Analysis from the Nationwide Inpatient Sample", "author": "Kumar", "doi-asserted-by": "crossref", "first-page": "A5831", "journal-title": "Chest", "key": "ref_38", "volume": "164", "year": "2023" }, { "DOI": "10.1186/s13054-021-03591-9", "article-title": "The impact of right ventricular injury on the mortality in patients with acute respiratory distress syndrome: A systematic review and meta-analysis", "author": "Sato", "doi-asserted-by": "crossref", "first-page": "172", "journal-title": "Crit. Care", "key": "ref_39", "volume": "25", "year": "2021" }, { "DOI": "10.1093/eurheartj/ehx504.P3532", "article-title": "P3532 Impact of systolic pulmonary artery pressure on long-term all-cause mortality in cardiovascular octogenarian patients", "author": "Barywani", "doi-asserted-by": "crossref", "first-page": "ehx504.P3532", "journal-title": "Eur. Heart J.", "key": "ref_40", "volume": "38", "year": "2017" }, { "DOI": "10.1186/s12947-020-00198-y", "article-title": "Prognostic implications of tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure ratio in septic shock patients", "author": "Zhang", "doi-asserted-by": "crossref", "first-page": "20", "journal-title": "Cardiovasc. Ultrasound", "key": "ref_41", "volume": "18", "year": "2020" }, { "article-title": "Long-term predictive value of cardiac biomarkers in patients with COVID-19 infection", "author": "Sabanoglu", "first-page": "6396", "journal-title": "Eur. Rev. Med. Pharmacol. Sci.", "key": "ref_42", "volume": "26", "year": "2022" }, { "DOI": "10.1016/j.jpsychires.2021.09.054", "article-title": "Onset and frequency of depression in post-COVID-19 syndrome: A systematic review", "author": "Lui", "doi-asserted-by": "crossref", "first-page": "129", "journal-title": "J. Psychiatr. Res.", "key": "ref_43", "volume": "144", "year": "2021" }, { "DOI": "10.1177/2324709620925571", "article-title": "Atrial Arrhythmias in a Patient Presenting With Coronavirus Disease-2019 (COVID-19) Infection", "author": "Seecheran", "doi-asserted-by": "crossref", "first-page": "2324709620925571", "journal-title": "J. Investig. Med. High Impact Case Rep.", "key": "ref_44", "volume": "8", "year": "2020" }, { "DOI": "10.1016/j.radi.2021.10.012", "article-title": "COVID-19 follow-up: Chest X-ray findings with clinical and radiological relationship three months after recovery", "author": "Fogante", "doi-asserted-by": "crossref", "first-page": "531", "journal-title": "Radiography", "key": "ref_45", "volume": "28", "year": "2022" }, { "DOI": "10.3390/jcm12041536", "doi-asserted-by": "crossref", "key": "ref_46", "unstructured": "Niebauer, J.H., Binder-Rodriguez, C., Iscel, A., Schedl, S., Capelle, C., Kahr, M., Cadjo, S., Schamilow, S., Badr-Eslam, R., and Lichtenauer, M. (2023). Cardiopulmonary Long-Term Sequelae in Patients after Severe COVID-19 Disease. J. Clin. Med., 12." }, { "DOI": "10.1080/17476348.2020.1743182", "article-title": "The long-lasting effects of the acute respiratory distress syndrome", "author": "Mart", "doi-asserted-by": "crossref", "first-page": "577", "journal-title": "Expert Rev. Respir. Med.", "key": "ref_47", "volume": "14", "year": "2020" } ], "reference-count": 47, "references-count": 47, "relation": {}, "resource": { "primary": { "URL": "https://www.mdpi.com/1999-4915/17/2/244" } }, "score": 1, "short-title": [], "source": "Crossref", "subject": [], "subtitle": [], "title": "Systolic Pulmonary Artery Pressure as Long-Term Mortality Predictor in Elderly Critically Ill with Severe COVID-19 Pneumonia", "type": "journal-article", "volume": "17" }