Supplementary Material for: The Effect of Borderline Pulmonary Hypertension on Survival in Chronic Lung Disease

Background: The impact of the new “borderline” hemodynamic class for pulmonary hypertension (PH) (mean pulmonary artery pressure [mPAP], 21–24 mm Hg and pulmonary vascular resistance, [PVR], ≥3 wood units, [WU]) in chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) is unclear. Objectives: The aim of this study was to assess the effect of borderline PH (BLPH) on survival in COPD and ILD patients. Method: Survival was analyzed from retrospective data from 317 patients in 12 centers (Italy, Spain, UK) comparing four hemodynamic groups: the absence of PH (NoPH; mPAP 2), and severe PH (SPH; mPAP ≥35 mm Hg or mPAP ≥25 mm Hg and CI 2). Results: BLPH affected 14% of patients; hemodynamic severity did not predict survival when COPD and ILD patients were analyzed together. However, survival in the ILD cohort for any PH level was worse than in NoPH (3-year survival: NoPH 58%, BLPH 32%, MPH 28%, SPH 33%, p = 0.002). In the COPD cohort, only SPH had reduced survival compared to the other groups (3-year survival: NoPH 82%, BLPH 86%, MPH 87%, SPH 57%, p = 0.005). The mortality risk correlated significantly with mPAP in ILD (hazard ratio [HR]: 2.776, 95% CI: 2.057–3.748, p p = 0.0146). Conclusions: In ILD, any level of PH portends worse survival, while in COPD, only SPH presents a worse outcome.研究背景：针对慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）与间质性肺疾病（interstitial lung disease, ILD）患者，新界定的临界型血流动力学分型肺动脉高压（pulmonary hypertension, PH）——即平均肺动脉压（mean pulmonary artery pressure, mPAP）为21~24 mmHg、肺血管阻力（pulmonary vascular resistance, PVR）≥3伍德单位（wood units, WU）——其临床影响尚不明确。 研究目的：本研究旨在评估临界肺动脉高压（borderline PH, BLPH）对COPD与ILD患者生存率的影响。 研究方法：本研究回顾性分析了来自意大利、西班牙、英国12家医学中心的317例患者数据，将受试者按血流动力学状态分为四组：无肺动脉高压组（NoPH；mPAP<21 mmHg）、临界肺动脉高压组（BLPH；mPAP 21~24 mmHg且PVR≥3 WU）、中度肺动脉高压组（MPH；mPAP 25~34 mmHg）及重度肺动脉高压组（SPH；mPAP≥35 mmHg，或mPAP≥25 mmHg且心脏指数<2 L·min⁻¹·m⁻²），并对各组生存率进行比较。 研究结果：共有14%的患者被归类为BLPH；当将COPD与ILD患者合并分析时，血流动力学严重程度无法预测患者生存率。然而，ILD队列中任意程度的PH患者生存率均差于NoPH组（3年生存率：NoPH组58%，BLPH组32%，MPH组28%，SPH组33%，p=0.002）。在COPD队列中，仅SPH组患者生存率较其他组显著降低（3年生存率：NoPH组82%，BLPH组86%，MPH组87%，SPH组57%，p=0.005）。ILD患者的死亡风险与mPAP呈显著正相关（风险比[hazard ratio, HR]=2.776，95%置信区间[confidence interval, CI]=2.057~3.748，p<0.001）；而COPD患者的死亡风险与mPAP仅存在临界相关性（HR=1.370，95%CI=1.073~1.750，p=0.0146）。 研究结论：在ILD患者中，任意程度的PH均提示预后不良；而在COPD患者中，仅SPH会导致不良临床结局。