Determinants of pulmonary hypertension group 3 in idiopathic pulmonary fibrosis

SESSION TITLE: Pulmonary Vascular Disease Posters 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Idiopathic pulmonary fibrosis (IPF) is the most common of the spontaneously occurring diffuse parenchymal lung diseases also known as idiopathic interstitial pneumonias. It affects patients in their sixth or seventh decade and can evolve quickly into an advanced disease. Pulmonary hypertension can complicate the course of this fibrotic disease, and when severe, can result in right ventricular failure, leading to accelerated mortality in this population. Concomitant risk factors for development of pulmonary hypertension in this setting have been sparsely reported in the literature; our study aims to identify these factors as means for appropriate screening and early detection of pulmonary hypertension. METHODS: Our study is a chart review investigation; data is derived from a large number of patients registered in the 2016- 2018 NIH/ NIS dataset. We included patients between the ages of 18 and 90, diagnosed with Idiopathic Pulmonary Fibrosis defined by the ICD code J84.112 and excluded patients with concomitant respiratory disorders that might bias the selection criteria. We then compared those who developed Pulmonary hypertension group 3 defined by the ICD code I27.23, excluding the other groups of pulmonary hypertension, with those who did not develop this complication, considering several patient-related variables which theoretically may prove such association. Univariate analysis was performed to evaluate correlation between groups, followed by multivariate analysis, using the R software version 4.1.3. A p-value of less than 0.05 was adopted for statistical significance. RESULTS: A total of 12221 patients with IPF were included in the study, of which 3001 patients developed pulmonary hypertension group 3 (24.5% of the studied population). Mean age was 61.3 years, 43.9% of patients were female, and 76.6% of patients were Caucasian. In the univariate then multivariate analysis, female patients were found to be at higher risk of developing pulmonary hypertension (OR= 1.25, p-value < 0.001), as well as those who have underlying coronary artery disease (OR= 1.26, p-value< 0.001), obesity (OR= 1.17, p-value< 0.014), pulmonary embolism (OR= 1.96, p-value< 0.001), atrial flutter (OR= 2.15, p-value< 0.001), and atrial fibrillation (OR= 1.25, p-value= 0.001). Those who died during their hospital admission were more likely to have had the primary outcome (OR= 1.25, p-value= 0.001), as opposed to those who were not admitted emergently (OR= 0.51, p-value<0.001), and interestingly to those with systemic hypertension (OR= 0.7, p-value< 0.001). Age and race did not however correlate with the development of pulmonary hypertension in the IPF setting. CONCLUSIONS: In this study, we demonstrated that in idiopathic pulmonary fibrosis, female gender, critical status, those who have coronary artery disease, obesity, pulmonary embolism, as well as atrial arrhythmias are at increased risk of developing pulmonary hypertension group 3, irrespective of the severity of IPF. CLINICAL IMPLICATIONS: When present in the patient population, the aforementioned factors would incite the clinician to start echocardiographic detection of pulmonary hypertension earlier than recommended, or to have closer surveillance. DISCLOSURES: No relevant relationships by Saif Abu-Baker No relevant relationships by Samer Asmar No relevant relationships by KHALIL EL GHARIB No disclosure on file for Dany El Sayegh No relevant relationships by Radu Grovu No relevant relationships by Georges Khattar No relevant relationships by Joanne Ling No relevant relationships by Ahmad Mustafa No relevant relationships by Fouad Sakr