Volume 32, Issue 1 (3-2025)
RJMS 2025, 32(1): 1-9 |
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Research code: 23053
Ethics code: 23053
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Kateb Z, Gandomi-Mohammadabadi A, Yadollahzadeh M, Abbasi M A, keshtkar Rajabi S. Investigating the Prevalence of Pulmonary Arterial Hypertension in People with COVID-19 and Its Relationship with the Severity and Outcome of the Disease. RJMS 2025; 32 (1) :1-9
URL: http://rjms.iums.ac.ir/article-1-8759-en.html
URL: http://rjms.iums.ac.ir/article-1-8759-en.html
Zahra Kateb 
, Alireza Gandomi-Mohammadabadi , Mahdi Yadollahzadeh , Mohammad Amin Abbasi * , Shahin Keshtkar Rajabi
, Alireza Gandomi-Mohammadabadi , Mahdi Yadollahzadeh , Mohammad Amin Abbasi * , Shahin Keshtkar Rajabi
Firoozabadi Hospital Clinical Research Development Unit (FHCRDU), Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran , amin.abbasi1314@gmail.com
Abstract: (308 Views)
Background & Aims: The coronavirus disease 2019 (COVID-19), first identified in Wuhan, China in December 2019, quickly spread worldwide and was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Since then, COVID-19 has caused major disruptions in the diagnosis, treatment, and follow-up of various chronic and acute conditions. Among these, pulmonary arterial hypertension (PAH) represents a particularly vulnerable clinical entity. PAH is a progressive disorder characterized by elevated pulmonary arterial pressure, vascular remodeling, and right ventricular dysfunction, which can result in severe morbidity and mortality if left untreated.Patients with pulmonary hypertension (PH) are known to respond differently to systemic illnesses compared to the general population. While in some acute medical conditions they may demonstrate relatively preserved outcomes due to chronic cardiovascular adaptations, the superimposition of COVID-19 has introduced unique clinical challenges. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative agent of COVID-19, primarily affects the respiratory system but also induces widespread endothelial injury, hypercoagulability, and systemic inflammation. These mechanisms can theoretically worsen pulmonary hemodynamics and exacerbate the clinical course of patients with PH.Early reports suggested that PH might increase the risk of complications such as hypoxemia, thromboembolic events, and right ventricular failure in COVID-19 patients. However, data on the true impact of PH on the severity and outcomes of COVID-19 remain limited and somewhat conflicting. Understanding this relationship is essential to guide targeted preventive measures, optimize hospital management, and reduce mortality in this high-risk subgroup.The present study was conducted at Firouzabadi Hospital during the first six months of the year 1400 (March–September 2021). The primary aim was to investigate the relationship between PH and COVID-19 severity and outcomes, including intensive care unit (ICU) admission and mortality. By clarifying this relationship, we sought to identify whether patients with PH required different management strategies compared to COVID-19 patients without PH.
Methods: This retrospective cross-sectional study included all patients admitted with confirmed COVID-19 to the COVID-19 wards of Firouzabadi Hospital. The study population was divided into two groups: patients with pulmonary hypertension (abnormal pulmonary arterial pressure, PAP) and patients without pulmonary hypertension (normal PAP).Demographic data including age and sex, as well as comorbidities such as cardiovascular disease, diabetes, and other underlying conditions, were extracted from patient files and recorded in standardized checklists. Echocardiographic data, including PAP and ejection fraction (EF), were also reviewed. Statistical analysis was performed using SPSS version 22. Categorical variables were compared using chi-square tests, and continuous variables were analyzed with t-tests. Multivariate logistic regression was used to evaluate the association of PH with mortality while controlling for confounding factors. A p-value of <0.05 was considered statistically significant.
Results: A total of 200 patients with confirmed COVID-19 were included. The prevalence of PH among these patients was 14% (29 patients). The mean age in the PH group was 51.1 years (range 26–88), compared to 47.8 years (range 2–91) in the non-PH group. Women represented 72.4% of the PH group, compared with 46.2% in the non-PH group, indicating a significant gender-related difference.Among the PH patients, five individuals had significant underlying comorbidities. ICU admission was required for 15 of the 29 PH patients (55.1%). Age showed a strong correlation with ICU admission in both groups. Mortality occurred in 8 of the 29 PH patients (27.5%). Importantly, there was no significant difference in mortality between the PH group and the non-PH group (27.5% vs. 26.2%).In terms of overall outcomes, 59 patients (29.5% of the entire cohort) required ICU care, and 53 patients (26.5%) died. Within the PH group, ICU admission occurred in 41.7%, and mortality was 27.8%. In comparison, in the non-PH group, 26.8% were admitted to ICU and 26.2% died. These findings indicate that although ICU admission was proportionally higher in the PH group, overall mortality was not statistically different. Initial EF was not associated with mortality in either group.
Conclusion: Our findings indicate that while pulmonary hypertension was present in a significant proportion of hospitalized COVID-19 patients (14%), it did not independently increase mortality risk compared to patients without PH. Although ICU admissions were more frequent among PH patients, the difference in death rates was not statistically significant.This result aligns with some recent studies that reported no independent association between PH and COVID-19 mortality after adjusting for age and comorbidities. However, other investigations have suggested that PH, particularly when associated with right ventricular dysfunction, may increase the risk of adverse outcomes. The discrepancy may be explained by differences in study populations, diagnostic criteria, and treatment approaches across centers.One possible explanation for our findings is that patients with chronic PH are often under close medical follow-up and receive vasodilator and anticoagulant therapies, which may have offered partial protection against COVID-19–related vascular complications. In addition, supportive measures such as early oxygen therapy and close hemodynamic monitoring might have helped mitigate severe outcomes in these patients.
Nevertheless, the higher ICU admission rate observed in the PH group suggests that these patients are more likely to experience severe acute decompensation during COVID-19 infection, even if their ultimate survival is not significantly worse. This emphasizes the need for vigilance, timely triage, and aggressive supportive care in COVID-19 patients with PH.Our study has limitations, including its retrospective design, single-center setting, and relatively small number of PH patients, which may reduce the generalizability of the results. Larger prospective studies are needed to validate these findings and to determine whether subgroups of PH patients, such as those with severe baseline hemodynamic impairment, may have different outcomes.
In this study, the prevalence of pulmonary hypertension among hospitalized COVID-19 patients was 14%. Although PH patients required ICU admission more frequently, their risk of death was not significantly higher than that of non-PH patients. Both groups experienced considerable mortality, underlining the severity of COVID-19 irrespective of baseline pulmonary pressures.
These results suggest that COVID-19 patients with PH should receive the same level of supportive and intensive care as other critically ill patients. Preventive strategies, close monitoring, and early interventions remain the cornerstone of management. Further multicenter studies with larger cohorts are necessary to refine risk stratification and optimize treatment strategies for this vulnerable population.
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