AB0858 PULMONARY ARTERIAL HYPERTENSION IN SYSTEMIC SCLEROSIS: A NATIONAL INPATIENT ANALYSIS

Abstract

Pulmonary arterial hypertension (PAH) is a chronic, progressive, and eventually fatal complication of Systemic Sclerosis (SS), affecting the prognosis and quality of life. Risk of PAH in SS is substantially high, and it causes early mortality. Non-specific manifestations of PAH can result in delayed diagnosis and result in poorer outcomes.We aim to study the prevalence and epidemiology of pulmonary arterial hypertension in SS, and impact of PAH on adult scleroderma hospitalizations in the United States population. We also aim to estimate the effect of PAH in SS on utilization of healthcare resources.We utilized the National Inpatient Sample (NIS) to obtain pertinent data. Total adult hospitalizations with primary diagnosis of SS and coexistent comorbidity of PAH were extracted from 2016-2019. We studied the demographic and epidemiological differences as well as mortality outcomes. Healthcare burden was estimated from total hospital charges (THC) and length of stay (LOS). Secondary outcomes including pulmonary embolism, atrial flutter/fibrillation, pneumonia, sepsis, cardiac & renal failure and ventilator requirements were also studied. Statistical analysis was performed on STATA, with linear and logistic regression analyses.Out of 126,685 adult scleroderma hospitalizations between 2016-19, 21930 (17%) presented with concurrent pulmonary hypertension. Females were significantly more in this group compared to patients with SS without PAH, representing approximately 85% of total admissions. Patients with PAH had a higher mean age (64.85±13.29 vs 62.56±14.51, P 0.000) as well. In terms of racial demographics, there was a significantly higher proportion of African American and significantly less Asians in the study group. Charlson comorbidity index was also higher >3 in the PAH group. PAH was associated with higher adjusted odds ratio (aOR) for mortality (aOR: 1.39, p<0.001), increased LOS (6.64 vs 6.0 days, p<0.001) increased THC ($83813 vs $71016, p <0.001). It was also associated with significantly higher odds for cardiac failure (aOR 3.13) and ventilator requirement (aOR 2.15). Secondary outcomes of kidney failure, Pulmonary embolism, atrial flutter/fibrillation, and pneumonia recorded a significantly higher aOR for patients with PAH. No significant difference in cardiac arrest, sepsis, or respiratory failure was noted.Pulmonary arterial hypertension in scleroderma is associated with worse overall outcomes in terms of mortality and morbidity, as well as much higher healthcare burden compared to SS without PAH. Also, PAH disproportionately affects African-american & Asian populations. Although advancements have been made in the treatment of PAH in SS, there still remains room for efforts directed towards early diagnosis and management to further improve outcomes for scleroderma patients.none.Table 1.Characteristics and Outcomes of adult scleroderma hospitalizations with & without PAHHospitalization Characteristics  and OutcomesSCL without PAHN = 104755SCL with PAHN = 21930P-ValueOdds ratio (OR)Female  87,829 (83.84%)18,730  (85.4%)0.023OR 1.12Age (Mean/SD)62.56/14.5164.85/13.290.000RaceWhite68774 (65.6%)13450 (61.3%)0.000OR 0.82African American15370 (14.6%)4290 (19.5%)0.000OR 1.41Hispanic11735 (11.2%)2505 (11.4%)0.721Asian PI18884 (18%)615 (2.8%)0.000OR 1.57Native American870 (0.8%)194 (0.88%)0.699Total died1410 (6.43%)4250 (4.01%)0.000 (1.39)Length of Stay (LOS) (Mean/SD)6.00 (7.72)6.64 (7.3)0.000Total hospital charges71016838130.000Secondary outcomesOdds ratioP-valueHeart failure3.130.000Pulmonary embolism1.840.000Cerebral infarction0.440.000Atrial Flutter/Atrial Fibrillation1.86/1.560.000/0.000Sepsis0.960.658Pneumonia1.220.000Ventilator2.150.000NIL.None Declared.