In-hospital outcomes of pulmonary hypertension in HIV patients: A population based cohort study

• Published in: International journal of cardiology Vol. 403; p. 131900
• Main Authors: Sanivarapu, Raghavendra R., Arjun, Shiva, Otero, Jonathan, Munshi, Rez, Akella, Jagadish, Iqbal, Javed, Zaki, Khawaja
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.05.2024
• Subjects: AIDS; HIV; In-hospital outcomes; Mortality; Pulmonary hypertension; Resource utilization; In-hospital outcomes; Resource utilization; ART; HIV; Mortality; PAH; AIDS; NIS; Pulmonary hypertension
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2024.131900

Pulmonary hypertension (PH) is a known complication of HIV infection. Outcomes of HIV-infected patients with PH (HIV-PH) have not been well established. We aim to assess various in-hospital outcomes such as mortality, resource utilization, and health care burden associated with HIV patients with concurrent PH. We used National Inpatient Sample (NIS) 2015 Quarter 4 through 2019 for this study. We identified patients using International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnostic codes with both HIV and pulmonary hypertension. Cohorts were weighted by NIS-provided algorithm which allows for national estimates. Univariate and multivariate regression analyses were used to determine odds ratios. A total of 910,120 patients were identified with HIV, among which 28,175 (3.19%) were identified to have concurrent PH. When compared to HIV alone, HIV-PH patients were older (54.53(±11.61) vs. 49.44(±13.11), predominantly black (64.45% vs. 51.8%%), more often male (57.2%), all p < 0.001. HIV-PH cohort had higher comorbidities with higher Charlson Comorbidity Index (CCI) (7.07(±3.53) vs. 5.17(±3.65), had slightly longer LOS [adjusted mean difference (aMD) 0.79], higher healthcare burden corrected for inflation (aMD $17,065); all p < 0.001. In univariate regression analysis, patients with HIV-PH had significantly higher rates of developing heart failure (aOR 10.44), cardiogenic shock (aOR 5.67), cardiomyopathy (aOR 4.97), in-hospital cardiac arrest (aOR 1.94), respiratory failure (aOR 3.29), invasive mechanical ventilation (aOR 1.71), aspiration pneumonia (aOR 1.29), acute kidney injury (aOR 2.14). Lastly, patients with HIV-PH had higher in-hospital mortality within 30 days of admission (aOR 1.28) & overall in-hospital mortality (aOR 1.23); p < 0.005). In patients with concomitant HIV and PH, there is a higher burden of comorbidities, and is associated with worse outcomes including mortality. Through this study, we highlight outcomes that will better risk stratifying patients with concurrent HIV and PH. •HIV-PH, presents a multifactorial pathogenesis involving both HIV-related factors and host factors.•The study utilized data from National Inpatient Sample (NIS) to assess outcomes in HIV-PH compared to those without PH.•Results showed that HIV-PH were older, likely to be male, predominantly black, and had higher Charlson comorbidity index.•HIV-PH patients also faced higher in-hospital mortality rates, longer hospital stays, and greater healthcare costs.•The study underscores the necessity for early detection and management of PH in HIV patients.