HOUSTON — Having comorbid chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH-COPD) increases the risk of hospitalizations and death compared to COPD alone, according to a new study.
Identifying PH in COPD is challenging, however, because performing right heart catheterization, the gold standard for PH diagnosis, is invasive and not routinely performed, pointed out the article in the journal COPD.1
The study team, led by researchers from the Michael E. DeBakey VAMC and Baylor College of Medicine, both in Houston, emphasized that clinical characterization of COPD patients at risk who are progressing toward PH will improve treatment earlier stages of PH-COPD, which is progressively fatal.
To come to that conclusion, the researchers reviewed records of 5,45,086 patients in a large VA healthcare network from 2000-2012; participants had a primary discharge diagnosis of COPD based on encounters’ ICD-9 codes and were further stratified into those who received an additional ICD-9 code for a PH diagnosis. Patients with PH-COPD were assigned to one of the four subgroups: those with (a) no history of exacerbation or hospital admissions, (b) history of exacerbations but no hospital admissions, (c) hospital admissions unrelated to COPD and (d) history of COPD exacerbation-related hospital admissions.
Associated comorbidities such as cardiac disease and the presence of obstructive sleep apnea (OSA) also were identified in the COPD and COPD-PH cohorts.
Analysis revealed that patients with COPD exacerbation-related hospital admissions had a seven times higher risk of having a concomitant clinical diagnosis of PH compared to non-hospitalized patients. In addition, COPD-PH patients had higher rates of cardiac comorbidities (89% vs. 66%) and OSA (34% vs. 16%) compared to COPD alone.
“We conclude that COPD patients hospitalized for COPD exacerbations are at a higher risk for developing PH, and hospitalized COPD patients with cardiac comorbidities and/or OSA should be screened as at-risk population for developing PH,” the researchers wrote.
1Medrek SK, Sharafkhaneh A, Spiegelman AM, Kak A, Pandit LM. Admission for COPD Exacerbation Is Associated with the Clinical Diagnosis of Pulmonary Hypertension: Results from a Retrospective Longitudinal Study of a Veteran Population. COPD. 2017 Oct;14(5):484-489. doi: 10.1080/15412555.2017.1336209. Epub 2017 Jul 17. PubMed PMID: 28715281.