Management and Outcomes in Pulmonary Arterial Hypertension Patients with Sepsis

Management and Outcomes in Pulmonary Arterial Hypertension Patients with Sepsis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Management and Outcomes in Pulmonary Arterial Hypertension Patients with Sepsis Spencer Flynn, Haidee Chen, Russell Kerbel, Summer Gupta, Sonia Jasuja, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3980177/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract INTRODUCTION: Sepsis is a common cause of death in patients with pulmonary arterial hypertension (PAH). Treatment requires careful fluid management and hemodynamic support. This study compares patients with or without PAH presenting with sepsis with a focus on initial fluid resuscitation. METHODS: This retrospective analysis compared adults with and without PAH admitted for sepsis at two academic hospitals between 2013-2022. Prior PAH diagnosis was verified by review of right heart catheterization data and sepsis present on admission was verified by chart review. Demographics, vital signs, laboratory values, imaging results, treatment approaches, and all-cause mortality data were obtained. Controls were propensity score weighted by age, sex, and Charlson Comorbidity index. Logistic regression models controlling for age and Charlson comorbidity indices were used to examine factors associated with survival. RESULTS: Thirty patients admitted for sepsis with pre-existing PAH were compared to 96 matched controls. Controls received significantly more fluids at 24 hours compared to PAH patients (mean 1503 mL v. 406 mL, p<0.001), while PAH patients were more likely to receive vasoactive medications (23.3% vs. 8.3%, p=0.037). At 30 days, 7 PAH patients (23.3%) and 13 control patients (13.5%) had died (p=0.376). PAH patients that received more fluids had decreased mortality (OR 0.93, 95% CI 0.84-0.98, p=0.03) and patients who received fluids had shorter mean time to antibiotics (2.3 hours v. 6.5 hours, p=0.04), although decreased time to antibiotics was not associated with mortality. Patients who received no fluids more often had previously identified right ventricular systolic dysfunction (62.5% v. 28.6%, p=0.136). CONCLUSION: Patients with PAH and sepsis have high mortality and receive different treatments than controls, with more reliance on vasopressors and less on fluid resuscitation. PAH patients who received less fluids had higher mortality and those who received no fluids had a longer time to receiving antibiotics, indicating a potential delay in recognizing sepsis. Timely recognition of sepsis and dynamic decision-making around fluid resuscitation remains critical in this high-risk population. pulmonary arterial hypertension sepsis fluid resuscitation Figures Figure 1 Figure 2 Introduction Pulmonary arterial hypertension (PAH) is a disease characterized by pulmonary arterial remodeling leading to increased pulmonary vascular resistance (PVR), right ventricular (RV) dysfunction, and right heart failure. 1,2 Sepsis is the second most common cause of in-hospital death in PAH patients. 3–5 Recent data suggests that about 25% of patients with PAH who present for sepsis will die while in the hospital. 3 Prompt recognition and treatment of sepsis is vital in the management of this high-risk condition. Sepsis causes numerous systemic changes with adverse effects on the cardiac and pulmonary systems. In sepsis, inflammatory mediators cause systemic vasodilation and capillary permeability, leading to a decrease in systemic vascular resistance (SVR), intravascular hypovolemia, microvascular thrombosis, tissue ischemia, and organ dysfunction. In contrast, PVR is often increased due to upregulated disease mediators such as serotonin, interleukin-6, and endotoxin. 6–10 A combination of increased metabolic needs due to infection and decreased SVR lead to a demand for markedly increased cardiac output to maintain sufficient mean arterial pressure (MAP) for tissue perfusion. Myocardial contractility and right ventricular contractility may be reduced in sepsis due to modulation of the adrenergic system by cytokines, nitric oxide, bacterial toxins, and damage-associated molecular patterns. 11,12 This effect may be potentiated in septic patients with PAH, who are at increased risk for acute on chronic right ventricular dysfunction and clinical heart failure compared to patients with isolated sepsis. 13,14 In summary, the physiologic effects of sepsis include decreased right ventricular preload, increased right ventricular afterload, and reduced contractility, all in the setting of higher demand for cardiac output. Each of these factors are further exacerbated in patients with PAH, with unique implications for management. Current management of sepsis in PAH patients includes treating the underlying etiology, optimizing preload, reducing right ventricular afterload, and supporting myocardial function to achieve adequate systemic perfusion. 15,16 Decisions around fluid management are particularly challenging in PAH patients with sepsis. Fluid resuscitation is recommended as part of initial resuscitation to restore preload in septic patients. 17 However, in septic patients with PAH a careful balance between providing fluids to improve preload has to be weighed against the risk of worsening right ventricular dilatation from fluid overload, which paradoxically could be heightened in sepsis due to sepsis-induced increased PVR. 10 Furthermore, differentiating sepsis from other causes of acute on chronic right ventricular dysfunction can be challenging given the relatively non-specific signs used to make an early diagnosis of sepsis. Finally, fluid administration may be complicated by ventricular interdependence, in which a dilated right ventricle causes the interventricular septum to shift towards the left ventricle with a subsequent decrease in left ventricular cardiac output. 18,19 Right ventricular dilatation also increases wall tension and can decrease right ventricular coronary perfusion. This presents a major challenge in the management of sepsis in PAH patients as right ventricular volume overload can lead to impaired cardiac output, with catastrophic implications for both the pulmonary and systemic circulations. 16,19 Currently, there is little data describing clinical characteristics or treatment strategies for sepsis in this acutely ill population. Guidelines for management of patients with sepsis recommend dynamic reassessment after initial resuscitation, but have not included subsets of patients with pulmonary arterial hypertension. 17 Prior studies show that patients with severe sepsis and septic shock presenting with clinical “volume overload” are less likely to receive 30 mL/kg crystalloid boluses within 3 hours of sepsis onset. 20,21 While this is associated with higher mortality, delayed hypotension, and increased ICU stay, these studies did not differentiate pulmonary arterial hypertension from other causes of volume overload, such as end-stage renal disease or heart failure with reduced left ventricular systolic function. Current treatment recommendations of PAH patients presenting with sepsis are based on expert opinion rooted in clinical practice or the results of registry or administrative database studies with incompletely characterized cohorts. This retrospective study investigates the treatment approaches and outcomes in a well-characterized cohort of patients with PAH verified by right heart catheterization who presented with sepsis between 2013–2022, with a particular focus on initial fluid resuscitation. Methods We conducted a retrospective cohort study of patients with PAH, compared to controls without PAH, who all presented for sepsis between 2013 and 2022 at two academic hospitals. PAH patients and controls were adults identified by an automated database search. Sepsis present on admission was identified by ICD-10 diagnosis codes. PAH patients were initially identified by ICD-10 codes for pulmonary arterial hypertension preceding their hospital admission. The specific ICD-10 codes used are listed in the Supplemental. PAH patients were admitted between October 1, 2015 – February 1, 2021, and controls were admitted between January 1st, 2013 and January 1st, 2022. Controls were enrolled in a 3:1 fashion compared to cases (PAH patients admitted with sepsis). After PAH patients and controls were identified, all subsequent data was obtained via manual chart review. Sepsis was defined as the presence of at least two of four systemic inflammatory response syndrome criteria within 24 hours of admission and a suspected source of infection. PAH patients were excluded for the following: lung and/or heart transplant, current left ventricular assist device, or missing/incomplete right heart catheterization data. Both PAH patients and controls were required to have at least 6 months of follow up data or to have died within 6 months of admission. Additional data obtained through chart review included demographics, vital signs, laboratory values, medications used prior to and during admission, intravenous fluids administered during the first 24 and 48 hours of admission, echocardiogram reports, and right heart catheterization reports. The study was approved by our institutional review board, Office of the Human Research Protection Program (OHRPP) IRB#22–000226. Outcomes Primary outcomes included mortality during or within 30 days of admission. Secondary outcomes included hospital length of stay, intensive care unit (ICU) length of stay, and mechanical ventilator use during admission. Subgroup analyses Patients were stratified by mortality during or within 30 days of admission, receipt of fluid resuscitation within 24 hours of admission, and by RV systolic function on pre-admission echocardiogram. Severe sepsis was defined as a lactate > 18 mg/dL or presence of acute kidney injury, and septic shock was defined per Sepsis-3 criteria as vasopressor requirements to maintain MAP > 65 and a lactate > 18 mg/dL. 22,23 Patients were identified who met the Severe Sepsis and Septic Shock Management Bundle (SEP-1) bundle criteria for fluid resuscitation within 3 hours of admission by presenting with initial SBP < 90, MAP 18 mg/dL. Finally, patients were categorized by right heart catheterization data as pre-capillary or mixed pre-post capillary pulmonary hypertension using criteria from the 6th World Health Symposium on Pulmonary Hypertension. 24 Acute kidney injury was defined using Kidney Disease Improving Global Outcomes (KDIGO) criteria. 25 Statistical Analysis Propensity score weighting by age, sex, and Charlson comorbidity index was performed for comparisons between patients and controls. Differences between the groups were evaluated by inverse probability weighted regression adjustments. Clinical characteristics and treatment approaches for PAH patients stratified by mortality, fluid resuscitation, and baseline RV systolic function were summarized. Differences between the PAH subgroups were measured by Kruskal-Wallis and Chi-square tests, as appropriate to the variable distribution. Logistic regression models were generated to determine the relationships between mortality and various predictors, including fluids given, vasopressor use, time to antibiotics, number of prior PAH therapies, mechanical ventilation, kidney injury, lactate levels, and various proxies of right ventricular dysfunction. All models were adjusted for age and Charlson comorbidity indices. P-values < 0.05 were considered statistically significant. All statistical analyses were performed with R version 4.0.5. (R Foundation for Statistical Computing, Vienna, Austria). Results There were 70 patients identified by ICD-10 codes as having PAH and sepsis present on admission. Thirty cases were included after verification of PAH and sepsis present on admission ( Figure 1 ). There were also 96 age and sex-matched controls reviewed. Among PAH patients, the average age was 57.2 years, 80% were female, 50% were white, 80% were on PAH-specific therapy, and 60% had either severe sepsis or septic shock ( Table 1 ). Hemodynamic measurements of cases with PAH and sepsis Among PAH patients, the most recent right heart catheterization was mean 15.2 months prior to admission, and the most recent echocardiogram was mean 7 months prior to admission ( Table 2 ). There were 20 patients with pre-capillary pulmonary hypertension, 6 with mixed pre-post capillary hypertension, and 4 categorized as neither but who on chart review had PAH ( Table 2 ). The mean ± SD pulmonary artery pressure was 42.1 ± 12.0 mmHg, with a pulmonary capillary wedge pressure of 11.9 ± 5.8 mmHg and a pulmonary vascular resistance of 7.0 ± 4.2 Wood Units (WU). The mean cardiac index was 2.9 ± 1.1 L/min/m 2 . The mean left ventricular ejection fraction was 72.1 ± 5.7%, with the majority (66.7%) having normal LV systolic function. There were 13 patients (43.3%) with flattened interventricular septa and 12 patients (40%) with dilated inferior vena cava. There were 14 (46.7%) patients with at least mild RV systolic dysfunction on prior echocardiogram (subgroup analysis included in Supplemental Table 1 ). Treatment approaches and outcomes PAH patients received lower volume intravenous fluids (mean, SD 406.1 ± 590.7 mL v. 1502.7 ± 1482.5 mL at 24 hours, p<0.001) ( Figure 2 ), and were more likely to receive vasopressors (23.3% v. 8.3% at 24 hours, p=0.037, Table 3 ). They also had non-significantly increased hospital lengths of stay (mean ± SD, 31.6 ± 48.5 days v. 17.5 ± 30.7 days, p=0.127), similar likelihood of mechanical ventilation (30% v. 22.9%, p=0.433), and greater mortality within 30 days (23.3% v. 13.5%, p=0.376). PAH patients who died during or within 30 days of admission were older (median, IQR 74 years (67-77.5) vs. 55 years (48.5-59), p=0.017) and had higher Charlson comorbidity indices (6 (5.5-7.5) vs. 4 (2-5.5), p=0.019) compared to those who survived ( Table 4 ). PAH patients who died were more likely to require high flow nasal cannula within 24 hours of admission (57.1% v. 21.7%, p=0.030). They also had significantly lower heart rates and temperature on admission compared to those who survived. Overall, those who died had similar rates of severe sepsis/septic shock, similar RV systolic function, and similar hemodynamic characteristics by right heart catheterization. They also had similar rates of PAH therapy prior to and during admission, vasopressor use, mechanical ventilation, hospital length of stay, and likelihood of being in the ICU. They had non-statistically significant increased likelihood of AKI present on admission (57.1% v. 26.1%), time to antibiotics (4.5 hours IQR 2.5-7.6 v 2.7 hours IQR 1.3-5.1) ( Table 4 ), and received less intravenous fluid in the first 24 hours (0 mL IQR 0-125 v. 250 mL IQR 0-900) ( Figure 2 ). There were 14 PAH patients who received fluid resuscitation within the first 24 hours, compared to 16 patients who received no fluids ( Table 5 ). Both groups had similar presenting vitals, laboratory findings, and sepsis severity. Only 28.6% of those who received fluids were on three PH drugs compared to 50% of patients who did not receive fluids, and those who received fluids were less likely to be on parental PH medication (35.7% v. 87.5%, p=0.011), had lower mean pulmonary artery pressures (37 mmHg IQR 27-45 vs. 45.5 mmHg IQR 40-52, p=0.037) and were less likely to have reduced RV systolic function (28.6% v. 62.5%, p=0.136). Those who received fluids had shorter time to antibiotics (2.3 IQR 1.2-4.5 hours vs. 6.5 IQR 2.5-19.1 hours, p=0.041) and were less likely to receive diuretics in the first 48 hours of their hospital stay (35.7% v. 81.2%, p=0.030). They also trended towards resolution of AKI within 48 hours (100% v. 50%) and greater improvement in lactate (median, IQR 6.5 mg/dL (0.8-10.2) v. 5 mg/dL (4-6)). Both groups had similar hospital lengths of stay. Interestingly, only 1 of the patients who received fluids died (7.1%), compared to 6 of the patients who did not receive fluids (37.5%), although this difference was not significant ( p=0.126). Logistic Regression Models of Survival Among Patients with Pulmonary Arterial Hypertension Hospitalized for Sepsis In the logistic regression models, increased fluid resuscitation at 24 hours or 48 hours were both significantly associated with decreased mortality ( Table 6, OR and 95% CI for each 250 mL of fluid given 0.93 (0.84-0.98), p=0.030, and 0.93 (0.84-0.97), p=0.024, respectively).A number of variables were non-significantly associated with higher likelihood of mortality, including vasopressor use, higher number of PH medications used at baseline, reduced RV systolic function, acute kidney injury on presentation, ICU stay during admission, and mechanical ventilation during admission. Time to antibiotics was also not associated with survival. Additional logistic regression models were generated to identify predictors of receiving intravenous fluid resuscitation (see Supplemental Table 2 ). A significant predictor for increased likelihood of receiving fluids was higher initial lactate (OR and 95% CI 1.23 (1.04-1.55,) p=0.049). Impaired RV systolic function on previous echocardiogram also predicted lower likelihood of receiving fluids (OR and 95% CI 0.14, (0.02-0.99), p=0.05). Discussion This retrospective study compared patients presenting with sepsis with and without PAH to characterize clinical presentation, treatment approach, and outcomes, with a focus on fluid resuscitation. The key findings of the present study are 1) PAH patients with sepsis had a high mortality rate of 23.3%, 2) PAH patients received less intravenous fluid resuscitation and were more likely to receive vasopressors than controls, 3) variables associated with increased mortality included age, Charlson comorbidity index, low heart rate, low temperature, and need for high flow nasal cannula within 24 hours of admission, while increased volume of fluid resuscitation in the first 24 hours of admission was associated with lower mortality. PAH patients had a high mortality rate of 23.3% compared to 13.5% among controls (p = 0.376). The lack of statistical difference may be due in part to lack of power, and notably the 23.3% mortality is similar to a large database study demonstrating a mortality rate of 25% in patients with PAH and sepsis. 1 He et al. examined 285 patients with sepsis and PAH and found lower mortality of 16.3%, however these patients may have been less ill, suggested by a lower rate of vasopressor use in both PAH patients and controls (3.1% and 2.3% use, compared to 33.3% and 8.3%, respectively, in this study). 14 Notably, the absolute difference in mortality between PAH patients and controls in our study was about 10% even with propensity score weighting of controls by Charlson comorbidity index. This suggests that PAH may increase mortality risk in sepsis beyond the comorbidity points assigned to heart failure in the index. In this study, controls received larger IV fluid volumes within 24 hours, while PAH patients were significantly more likely to receive vasopressors within 24 hours. This suggests a difference in the approach to initial resuscitation in patients with PAH and sepsis compared to patients without PAH. The 2021 Surviving Sepsis Guidelines recommend fluid resuscitation as first line in patients with sepsis and organ hypoperfusion or septic shock, yet PAH patients with hypotension in this study frequently received pressors as the first treatment rather than IV fluid. 17 This difference in management may in part be due to the challenge facing physicians in differentiating sepsis from cardiac decompensation in patients with PAH. While all patients presented with at least two of four SIRS criteria, only about 40% of this cohort had positive blood cultures supporting a definitive infectious etiology. These findings highlight the diagnostic challenge that underlying PAH represents in the setting of organ malperfusion or hypotension, and may complicate the optimal volume management strategy given the risk of RV dysfunction with IV fluid administration. 19,26 We found that fluid resuscitation may be beneficial in select PAH patients, as increased fluid boluses were associated with lower mortality in our cohort. It is worth noting that two recent randomized controlled trials of patients with severe sepsis or septic shock found no difference in mortality between restrictive or liberal fluid resuscitation strategies. 27,28 However, in both studies patients included only very ill patients with either severe sepsis or septic shock, and considerably more fluids were administered in the restrictive arm (mean 1.27 liters and over 2 liters) than were administered to the PAH patients in the present study (mean 0.41 L), and so their results likely do not generalize to our cohort. In the present study, IV fluids were associated with decreased mortality, non-significantly higher likelihood of resolution of AKI and improvement in lactate levels. Notably, these PAH patients had similar presenting vital signs, brain natriuretic peptide levels, and SEP-1 bundle criteria rates compared to controls. Fluid resuscitation was also associated with significantly early administration of antibiotics, suggesting earlier recognition of sepsis although time to antibiotics was not associated with improved mortality in this cohort. 29,30 PAH patients who did not receive fluids had higher mean pulmonary artery pressures and trended towards greater RV dysfunction on transthoracic echocardiogram, which may have impacted the fluid management strategy and mortality. Analysis of patients with echocardiographic RV dysfunction is included in Supplement 1. Limitations to this study include its retrospective nature and small sample size. The patients’ presenting volume status and any beside evaluation of cardiac function were not available. Multiple confounders could underly the finding of increased fluid resuscitation and improved mortality, particularly that patients with worse RV dysfunction may be both less likely to receive IV fluids given concerns of right ventricular dilatation and may also have higher mortality due to their cardiac dysfunction. To our knowledge, this is the first study of PAH and sepsis that incorporated right heart catheterization data and chart review to generate a validated, well-characterized cohort of patients with PAH and sepsis. The few published studies on PAH and sepsis used large scale administrative databases or registries and lacked objective confirmation of PAH and sepsis. 13,14 It is notable that our initial database search using ICD-10 codes generated 70 patients identified as having PAH and sepsis on presentation, but that after chart review only 30 patients were found to meet inclusion criteria. Further, while our small sample size was a limitation in terms of statistical power, it also allowed for complete phenotyping of each case. Conclusion This was a retrospective study characterizing patients with PAH who presented with sepsis compared to propensity weighted controls without PAH. Patients with underlying PAH had high mortality, received lower volume of fluids during initial resuscitation, and had higher rates of vasopressor use. Among PAH patients, those who received fluid resuscitation had improved mortality and shorter time to antibiotics. These findings reflect the challenges around early fluid resuscitation in PAH patients presenting with sepsis, weighing the risks of precipitating RV decompensation against under-resuscitating a septic patient. These findings also suggest that early identification of sepsis in these patients is critical in shortening time to antibiotics. Further research is needed to help guide decision-making around early fluid management in patients with PAH presenting with sepsis. Declarations Ethical Approval The study was approved by our institutional review board, Office of the Human Research Protection Program (OHRPP) IRB#22-000226. Consent for publication Not applicable Funding No funding was used to complete this research. Availability of data and materials The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Author Contribution S.F., R.K., S.G., R.S., R.C., and A.S. contributed to the conception and design of the work. S.F. assisted with the data analysis and prepared Figures 1-2. S.F., H.C., A.S., R.K., R.S., R.C., and S.J interpreted the findings and substatntively revised the work. S.F., H.C., and A.S. acquired the data and wrote the main manuscript text. All authors reviewed the manuscript and approved the submitted version. References Trammell AW, Shah AJ, Phillips LS, Michael Hart C. Mortality in US veterans with pulmonary hypertension: a retrospective analysis of survival by subtype and baseline factors. Pulm Circ . 2019;9(1). doi:10.1177/2045894019825763 Ruopp NF, Cockrill BA. Diagnosis and Treatment of Pulmonary Arterial Hypertension: A Review. JAMA . 2022;327(14):1379-1391. doi:10.1001/JAMA.2022.4402 Harder EM, Small AM, Fares WH. Primary cardiac hospitalizations in pulmonary arterial hypertension: Trends and outcomes from 2001 to 2014. 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Chest . 2019;155(5):938-946. doi:10.1016/J.CHEST.2019.02.008 Tables Table 1: Demographics and Clinical Characteristics of Patients with Pulmonary Arterial Hypertension Admitted for Sepsis Compared to Propensity-Weighted Controls PAH patients (n=30) Controls (n=96) P-value Age 57.2 ± 16.5 57.6 ± 16.3 0.361 Sex, Female 24 (80%) 73 (76%) 0.522 Race White Black Asian Other 15 (50%) 6(20.0%) 1 (3.3%) 8 (26.6%) 58 (60.4%) 5 (5.0%) 11 (12.1%) 22 (22.6%) 0.399 0.031 0.008 0.818 Charlson comorbidity index 4.0 ± 2.6 3.9 ± 2.5 0.237 Presenting vitals and laboratory data MAP, mmHg Respiratory rate, per minute Temperature, Fahrenheit Heart rate, per minute SpO2, % WBC, x10 3 /µL Lactate, mg/dL Creatinine, mg/dL BNP, pg/mL 76.2 ± 16.8 21.5 ± 5.2 98.8 ± 1.7 94.7 ± 21.6 91.9 ± 7.1 9.7 ± 5.3 16.7 ± 12.1 1.97 ± 2.08 876.4 ± 727.9 90.6 ± 16.1 20.1 ± 5.7 99.1 ± 2.2 100.8 ± 21.2 95.4 ± 7.2 14.2 ± 10.3 20.1 ± 18.8 1.47 ± 1.39 600.0 ± 768.2 <0.001 0.133 0.391 0.157 0.014 0.002 0.191 0.127 0.139 Blood culture, positive at 24 hours 12 (41.4%) 24 (25.2%) 0.128 Sepsis category Sepsis Severe sepsis Septic shock 12 (40%) 9 (30%) 9 (30%) 32 (30.2%) 59 (61.8%) 8 (8.0%) 0.372 <0.001 0.007 SEP-1 Bundle 14 (46.7%) 34 (35.5%) 0.224 Time to antibiotics, hours 7.4 ± 5.0 5.0 ± 11.3 0.370 PH medication during admission, categorical 26 (86.7%) N/A N/A Received parenteral PH medication during admission 10 (33.3%) N/A N/A Baseline PH medications used, categorical 24 (80%) N/A N/A Number of baseline PH medications used 0 1 2 3 6 (20%) 6 (20%) 5 (16.7%) 13 (43.4%) N/A N/A Maximal supplemental oxygen use at 24 hours ETT PPV HFNC NRB NC Room air 0 1 (3.3%) 10 (33.6%) 2 (6.6%) 13 (43.3%) 4 (13.3%) 6 (6.3%) 4 (4.2%) 2 (2.1%) 8 (8.3%) 31 (32.3%) 45 (46.9%) 0.012 0.440 <0.001 0.594 0.276 <0.001 Abbreviations: MAP = mean arterial pressure, SpO2 = oxygen saturation, WBC = White blood cell count, BNP = brain natriuretic peptide, PH = pulmonary hypertension, ETT = endotracheal intubation, PPV = positive pressure ventilation, HFNC = high flow nasal cannula, NRB = non-rebreather mask, NC = nasal cannula PAH patients and controls were propensity score weighted by Charlson Comorbidity index, age, and sex. All numeric values are reported as mean ± SD. P-values are from Inverse Probability Weighted Regression Adjustment. All vital signs and lab values reported are the earliest available values during the qualifying encounter for sepsis. *p<0.05, **p<0.01, ***p<0.001 Table 2: Hemodynamic Measurements Prior to Admission of Patients with Pulmonary Arterial Hypertension All PAH patients (n=30) Precapillary PH group (n=20) Mixed PH group (n=6) Uncategorized group (n=4) Sex, female 24 (80%) 17 (85%) 4 (67%) 3 (75%) Time from RHC to admission for sepsis, months 15.2 ± 16.9 11.8 ± 8.2 13.8 ± 9.8 34.4 ± 40.1 Mean RAP, mmHg 8.9 ± 5.3 7.8 ± 4.1 14.8 ± 6.6 5.5 ± 1.3 Mean PAP, mmhG 42.1 ± 12.0 41.3 ± 11.8 50.6 ± 10.9 33.3 ± 7.9 PCWP, mmHg 11.9 ± 5.8 9.3 ± 4.1 21.4 ± 2.5 13 ± 1.4 CO, thermodilution, L/min 5.1 ± 2.1 4.4 ± 1.3 4.8 ± 1.4 9.0 ± 1.6 CO, Fick, L/min 4.6 ± 1.0 4.5 ± 1.1 4.7 ± 0.3 NA CI, thermodilution, L/min/m 2 2.9 ± 1.1 2.7 ± 0.8 2.4 ± 0.7 5.2 ± 0.7 CI, Fick, L/min/m 2 2.3 ± 0.4 2.4 ± 0.4 2.2 ± 0.1 NA PVR, WU 7.0 ± 4.2 8.2 ± 4.2 6.0 ± 3.2 2.2 ± 0.6 Time from TTE data to admission for sepsis, months 6.9 ± 11.3 4.1 ± 4.0 7.5 ± 6.7 20.4 ± 27.8 LA size Normal Enlarged 16 (53.3%) 14 (46.7%) 11 (55%) 9 (45%) 2 (33.3%) 4 (66.6%) 3 (75%) 1 (25%) LVEF, % 72.1 ± 5.7 70 ± 8.7 73.3 ± 2.9 75 (NA) LV systolic function Normal Mildly reduced Hyperdynamic 20 (66.7%) 1 (3.3%) 9 (30%) 15 (75%) 1 (5%) 4 (20%) 3 (50%) 0 3 (50%) 2 (50%) 0 2 (50%) IV septum description, flattened 13 (43.3%) 12 (60%) 1 (16.7%) 0 IV septum diameter, cm 1.1 ± 0.3 1.1 ± 0.4 1.1 ± 0.3 1.2 ± 0.3 Diastolic function description Normal Grade I dysfunction Grade II dysfunction Not described 12 (40%) 9 (30%) 1 (3.3%) 8 (26.7%) 9 (45%) 5 (25%) 0 6 (30%) 1 (16.7%) 3 (50%) 0 2 (33.3%) 2 (50%) 1 (25%) 1 (25%) 0 RV size Normal Mildly enlarged Moderately enlarged Severely enlarged 10(33.3%) 8 (26.7%) 3 (10%) 9 (30%) 4 (20%) 7 (35%) 2 (10%) 7 (35%) 4 (66.7%) 0 0 2 (33.3%) 2 (50%) 1 (25%) 1 (25%) 0 RV systolic function Normal Mildly reduced Moderately reduced Severely reduced Not commented 15 (50%) 5 (16.7%) 3 (10%) 6 (20%) 1 (3.3%) 8 (40%) 3 (15%) 3 (15%) 5 (25%) 1 (5%) 5 (83.3%) 0 0 1 (16.7%) 0 2 (50%) 2 (50%) 0 0 0 TAPSE, cm 1.9 ± 0.5 1.9 ± 0.6 1.7 ± 0.4 2.3 ± 0.3 DTI, cm/s 12.7 ± 2.6 12.0 ± 1.8 12.3 ± 2.4 17.8 ± 1.1 Tricuspid regurgitation description Trace Mild Mild-moderate Moderate Moderate-severe Severe Not commented 8 (26.7%) 6 (20%) 5 (16.7%) 3 (10%) 4 (13.3%) 3 (10%) 1 (3.3%) 5 (25%) 4 (20%) 4 (20%) 2 (10%) 2 (10%) 3 (15%) 0 1 (16.7%) 0 1 (16.7%) 1 (16.7%) 2 (33.3%) 0 1 (16.7%) 2 (50%) 2 (50%) 0 0 0 0 0 Tricuspid regurgitation velocity, m/s 3.6 ± 0.9 3.6 ± 1.0 3.8 ± 0.7 3.0 ± 0.6 Estimated RVSP/PASP 63.4 ± 28.4 66.1 ± 29.4 71 ± 23.8 36.7 ± 14.7 IVC dilated, yes 12 (40%) 9 (45%) 2 (33.3%) 1 (25%) IVC respiratory change, <50% 19 (63.3%) 12 (60%) 6 (100%) 1 (25%) Pericardial effusion None or trace Small Moderate Large 25 (83.3%) 2 (6.7%) 2 (6.7%) 1 (3.3%) 17 (85%) 1 (5%) 1 (5%) 1 (5%) 4 (66.7%) 1 (13.3%) 1 (13.3%) 0 4 (100%) 0 0 0 Abbreviations: RHC = right heart catheterization, RAP = right atrial pressure, PAP = pulmonary artery pressure, PCWP = pulmonary capillary wedge pressure, CO = cardiac output, CI = cardiac index, PVR = pulmonary vascular resistance, WU = Wood units , LA = left atrium, LVEF = left ventricular ejection fraction, IV = interventricular, RV = right ventricle, TAPSE = tricuspid annular plane systolic excursion, DTI =doppler tissue echocardiography, RVSP/PASP = right ventricular systolic pressure/pulmonary artery systolic pressure, IVC = inferior vena cava. All numeric variables are mean ± SD unless otherwise indicated. Hemodynamic categories were defined by World Health Symposium on Pulmonary Hypertension criteria: precapillary is mPAP>20mmHG, PCWP≤15mmHG, and PVR≥3WU. Mixed is mPAP>20mmHG, PCWP>15, PVR≥3WU. Uncategorized has hemodynamic values that do not fall into any group. Table 3: Treatment Approaches and Outcomes in Pulmonary Arterial Hypertension Patients Admitted for Sepsis Compared to Controls All PAH patients (n=30) Controls (n=96) P-value Precapillary PH group (n=20) Mixed PH group (n=6) Uncategorized group (n=4) IV fluid boluses in first 24 hours, mL 406.1 ± 590.7 1502.7 ± 1482.5 <0.001 443.7 ± 720 371.7 ± 670.8 171.5 ± 382.6 IV fluid boluses in first 48 hours, mL 563.0 ± 766.7 2232.4 ± 3930.5 <0.001 581.4 ± 951.3 371.7 ± 670.9 853.2 ± 865.6 Vasopressor use in first 24 hours 7 (23.3%) 8 (8.3%) 0.037 5 (25%) 2 (33.3%) N/A Vasopressor use in first 48 hours 10 (33.3%) 8 (8.3%) 0.004 7 (35%) 3 (50%) N/A Hospital length of stay, days 31.6 ± 48.5 17.5 ± 30.7 0.127 37.7 ± 65.8 17.2 ± 17.2 15.8 ± 24.9 Mechanical ventilation during admission 9 (30%) 22 (22.9%) 0.433 6 (30%) 2 (33.3%) 1 (25%) Mortality during admission or within 30 days 7 (23.3%) 13 (13.5%) 0.376 3 (15%) 3 (50%) 1 (25%) Abbreviations: IV = intravenous, PH = pulmonary hypertension PAH patients and controls were propensity score weighted by Charlson Comorbidity index, age, and sex. All numeric variables are mean ± SD unless otherwise indicated. P-values are from Inverse Probability Weighted Regression Adjustment. Table 4: Characteristics and Treatment Approaches of Patients with Pulmonary Arterial Hypertension Admitted for Sepsis by Mortality Alive (n=23) Deceased (n=7) P-value Age 55 (48.5-59) 74 (67-77.5) 0.017 Sex, female 19 (82.6%) 5 (71.4%) 0.914 Race White Black Asian Other White 9 (39.1%) Black 6 (26.1%) Other 7 (30.4%) White 6 (85.7%) Black 1 (14.3%) 0.166 Charlson comorbidity index 4 (2-5.5) 6 (5.5-7.5) 0.019 Presenting vitals and laboratory data MAP, mmHg Respiratory rate, per minute Temperature, Fahrenheit Heart rate, per minute SpO2, % WBC, x10 3 /µL Serum lactate, mg/dL BNP, pg/mL 74.7 (66.8-88.3) 20 (18-25) 98.5 (98-100.5) 103 (88.5-110.5) 95 (92.5-96) 7.1 (6-11.3) 13 (8-19.5) 494 (223.2-1265.8) 68 (62.8-79.7) 18 (17-19) 97.5 (97.3-97.9) 74 (68-85.5) 90 (87-94.5) 11.1 (10.1-12.7) 14 (10-16.5) 890 (356.5-1378.0) 0.249 0.156 0.006 0.013 0.209 0.249 0.702 0.619 Blood culture, positive 7 (30.4%) 2 (28.6%) 0.349 Sepsis category Sepsis Severe sepsis Septic shock 10 6 7 2 3 2 0.668 SEP-1 Bundle criteria 11 (47.8%) 3 (42.9%) 1.000 PH medication during admission 19 (82.6%) 7 (100%) 0.582 Received parenteral PH medication during admission 14 (60.9%) 5 (71.4%) 0.952 Baseline PH medication use, yes 18 (78.3%) 7 (100%) 0.440 Number of baseline PH medications used 0 1 2 3 0 (21.7%) 1 (17.4%) 2 (17.4%) 3 (43.5%) 0 3 (42.9%) 2 (28.6%) 2 (28.6%) 0.302 Supplemental oxygen use at 24 hours None NC NRB HFNC 4 (17.4%) 13 (56.5%) 1 (4.3%) 5 (21.7%) 0 (0%) 2 (14.3%) 1 (14.3%) 4 (57.1%) 0.030 Time to antibiotics, hours 2.7 (1.3-5.1) 4.5 (2.5-7.6) 0.441 PCWP, mmHg 11 (8-14) 12 (8.5-14.5) 0.459 Mean RAP, mmHg 7 (5-12.5) 10 (8.5-10.5) 0.403 Mean PAP, mmHg 41 (32-49.8) 45 (40-48.5) 0.556 PVR, WU 7.8 (3.3-9.7) 5.8 (4.2-6.8) 0.351 CI, thermodilution, L/min/m 2 2.6 (2.1-3.4) 2.9 (2.9-3.0) 0.301 RV systolic function reduced 11 (47.8%) 3 (42.9%) 1.000 Change in lactate -5.5 (-9.2, -0.8) -7 (-26, -7) 0.148 Change in creatinine, 24 hours -0.1 (-0.2-0.1) -0.1 (-0.9-0.1) 0.683 AKI present on admission 6 (26.1%) 4 (57.1%) 0.146 AKI resolved by 48 hours 6 (27.3%) 2 (28.6%) 0.395 Mechanical ventilation used during admission 7 (30.4%) 2 (28.6%) 1.000 IV fluid boluses in first 24 hours, mL 250 (0-900) 0 (0-125) 0.150 IV fluid boluses in first 48 hours, mL 250 (0-1500) 0 (0-400) 0.183 Diuretic use in first 24 hours 10 (43.5%) 4 (57.1%) 0.840 Diuretic use in first 48 hours 14 (60.9%) 4 (57.1%) 1.000 Vasopressor use in first 24 hours 5 (21.7%) 2 (28.6%) 1.000 Vasopressor use in first 48 hours 8 (34.8%) 2 (28.6%) 1.000 Hospital length of stay 15 (8-38.2) 11 (7.5-20.5) 0.628 ICU stay during admission 14 (60.9%) 4 (57.1%) 1.000 ICU length of stay 23.5 (13.5-30) 21 (11-59.1) 1.000 Abbreviations: MAP = mean arterial pressure, SpO2 = oxygen saturation, WBC = White blood cell count, RAP = right atrial pressure, PAP = pulmonary artery pressure, PCWP = pulmonary capillary wedge pressure, CI = cardiac index, PVR = pulmonary vascular resistance, WU = Wood units, ICU = intensive care unit. All vital signs and lab values reported are the earliest available values during the qualifying encounter for sepsis. All numeric values are reported as median (IQR) and p-values are from Kruskal-Wallis tests. *p<0.05, **p<0.01, ***p<0.001 Table 5: Clinical Characteristics and Treatment Approaches by Fluid Administration within 24 Hours No Fluids (n=16) Received Fluids (n=14) P-value Age 58 (52.8-67.2) 57.5 (47-73.5) 0.901 Sex, female 13 (81.2%) 11 (78.6%) 1.000 Race White Black Asian Other 8 (50%) 3 (18.8%) 0 5 (31.2%) 7 (50%) 4 (28.6%) 1 (7.1%) 2 (14.3%) 0.499 Charlson comorbidity index 4 (2-6) 5 (2.2-6) 0.659 Presenting vitals and laboratory data MAP, mmHg Respiratory rate, per minute Temperature, Fahrenheit Heart rate, per minute SpO2, % WBC, x10 3 /µL Serum lactate, mg/dL BNP, pg/mL 72 (66.3-85.6) 20 (17.5-22.5) 98 (97.7-98.6) 91.5 (78.5-104.2) 94 (88.5-95.2) 9.2 (5.7-11.1) 11.5 (9-14.2) 561 (347-1332.5) 73.5 (66-84.7) 18.5 (18-23.8) 98.7 (98.1-101.2) 103.5 (83-110.8) 94.5 (93-96) 8.6 (6.2-14.1) 18 (8-23) 509 (216.5-1180.5) 0.950 0.983 0.070 0.270 0.452 0.280 0.124 0.626 Blood culture, positive 6 (37.5%) 3 (21.4%) 0.144 Sepsis category Sepsis Severe sepsis Septic shock 8 (50%) 3 (18.8%) 5 (31.3%) 4 (28.6%) 6 (42.9%) 4 (28.6%) 0.313 SEP-1 Bundle criteria 8 (50%) 6 (42.9%) 0.980 PH medication during admission 15 (93.8%) 11 (78.6%) 0.495 Received parenteral PH medication during admission 14 (87.5%) 5 (35.7%) 0.011 Baseline PH medication use, yes 15 (93.8%) 10 (71.4%) 0.252 Number of baseline PH medications used 0 1 2 3 ­ 1 (6.2%) 4 (25%) 3 (18.8%) 8 (50%) 4 (28.6%) 3 (21.4%) 3 (21.4%) 4 (28.6%) 0.368 Supplemental oxygen use at 24 hours None NC NRB HFNC PPV 2 (12.5%) 5 (31.2%) 1 (6.2%) 7 (43.8%) 1 (6.2%) 2 (14.3%) 9 (64.3%) 1 (7.1%) 2 (14.3%) 0 0.235 Time to antibiotics, hours 6.5 (2.5-19.1) 2.3 (1.2-4.5) 0.041 Most recent RHC findings, PCWP, mmHg Mean RAP, mmHg Mean PAP, mmHG PVR, WU CI, thermodilution, L/min 13 (10.5-14.5) 8.5 (5-12.5) 45.5 (40-52) 7.9 (4.3-10.1) 2.8 (2.2-3.4) 9.5 (7.2-13.8) 7.5 (5.2-10.8) 37 (27-45) 4.7 (3.4-8.2) 2.9 (2.3-3.1) 0.265 0.602 0.037 0.270 0.982 TAPSE, cm 1.8 (1.8-2.0) 2.2 (1.8-2.5) 0.154 RV systolic function Normal Mildly reduced Moderately reduced Severely reduced 6 (37.5%) 3 (18.8%) 2 (12.5%) 5 (31.2%) 9 (64.3%) 2 (14.2%) 1 (7.1%) 1 (7.1%) 0.464 RV systolic function reduced 10 (62.5%) 4 (28.6%) 0.136 Change in lactate -5 (-6, -4) -6.5 (-10.2, -0.8) 0.613 Change in creatinine at 24 hours -0.1 (-0.2, 0) 0.0 (-0.3, 0.1) 0.539 AKI present on admission 4 (25%) 6 (42.9%) 0.560 Resolution of AKI present on admission within 48 hours 2 (13.3%) 6 (42.9%) 0.179 DTI, cm/sec 11.1 (11-14) 12.9 (10.8-15.0) 0.825 Mechanical ventilation used during admission 4 (25%) 5 (35.7%) 0.811 IV fluid boluses in first 24 hours, mL 0 (0-0) 775 (512.5-1375.0) <0.001 IV fluid boluses in first 48 hours, mL 0 (0-0) 1025 (512.5-1518.5) <0.001 Diuretic use in first 24 hours 9 (56.2%) 5 (35.7%) 0.448 Diuretic use in first 48 hours 13 (81.2%) 5 (35.7%) 0.030 Vasopressor use in first 24 hours 4 (25%) 3 (21.4%) 1.000 Vasopressor use in first 48 hours 7 (43.8%) 3 (21.4%) 0.365 Hospital length of stay 16 (11-36) 9 (7-29.2) 0.304 ICU stay during admission 11 (68.8%) 7 (50%) 0.501 ICU length of stay 22 (12-30) 25 (13-33.5) 1.000 Abbreviations: MAP = mean arterial pressure, SpO2 = oxygen saturation, WBC = White blood cell count, RAP = right atrial pressure, PAP = pulmonary artery pressure, PCWP = pulmonary capillary wedge pressure, CI = cardiac index, PVR = pulmonary vascular resistance, WU = Wood units All vital signs and lab values reported are the earliest available values during the qualifying encounter for sepsis. All numeric values are reported as median (IQR) and p-values are from Kruskal-Wallis tests. *p<0.05, **p<0.01, ***p<0.001 Table 6: Logistics Regression of Survival Among Patients with Pulmonary Arterial Hypertension Hospitalized for Sepsis Quantity fluid boluses given at 24 hours, per 250 cc 0.93 (0.84-0.98), p=0.03 Quantity fluid boluses given at 48 hours, per 250 cc 0.93 (0.84-0.97), p=0.024 Vasopressor use at 24 hours 55.3 (1.5-10989), p=0.06 Vasopressor use at 48 hours 4.47 (0.32-116), p=0.29 PH medication use at baseline, ordinal of 0, 1, 2, or >=3 medications 3.84 (0.85-48.26), p=0.16 Time to antibiotics, hours 1.02 (0.83-1.18), p=0.75 Mechanical ventilation during admission 2.25 (0.17-31.71), p=0.51 TAPSE, continuous 4.42 (0.12-703), p=0.47 RV systolic function at least mildly impaired 1.80 (0.16-25.0), p=0.63 AKI on presentation 3.63 (0.34-51.7), p=0.29 ICU stay during admission 3.24 (0.38-48.1), p=0.32 Abbreviations: TAPSE = tricuspid annular plane systolic excursion, RV = right ventricle, DTI =doppler tissue echocardiography All values reported are odds ratios generated from logistic regression analyses adjusted for age, sex, and Charlson Comorbidity Index at admission. Additional Declarations No competing interests reported. Supplementary Files PAHSepsisSupplement.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Sherman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIiWNgGAWjYFACHgjFD8QSECZzA4ggrEWyAazFAMhkJFKLwQFitfD3nz34uDLHLs/42uGDtwsq/jAYHD/Y+IGhwjqxAYcWiRt5yYZntyUXm91OS7aeccaAweBMYrMEw5l0nFoYbvCYSTZuY07cdjvHTJq3DajlBmODBGPbYZxa5M+fMf/ZuK0+cfPs/G/SvP/AWpp/MP7DrcXgQI4ZY+O2w4kbpHPYpHkbwFraJBgbcGsxvJFjDHTY8cQZt9OMrXmOGfNInklss0g4lm6MS4vc+TOGHxu3VSf2z05+eJunRk6O7/jhwzc+1FjL4vQ+OoBEUwKxykfBKBgFo2AUYAUAjhZa4WlffuMAAAAASUVORK5CYII=","orcid":"","institution":"University of California, Los Angeles","correspondingAuthor":true,"prefix":"","firstName":"Alexander","middleName":"","lastName":"Sherman","suffix":""}],"badges":[],"createdAt":"2024-02-23 00:29:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3980177/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3980177/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54321872,"identity":"b4c91847-47ff-4700-8404-7dbb789fbe90","added_by":"auto","created_at":"2024-04-08 19:40:19","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":75519,"visible":true,"origin":"","legend":"\u003cp\u003eFlow Diagram of Inclusion and Exclusion of Subjects\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3980177/v1/af9485c5271f686960a41700.jpg"},{"id":54321873,"identity":"00b8101f-2f2a-4519-8be3-8507887d3e28","added_by":"auto","created_at":"2024-04-08 19:40:19","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":20485,"visible":true,"origin":"","legend":"\u003cp\u003eFluid boluses given. \u003cstrong\u003eA) \u003c/strong\u003eFluid boluses given in 24 hours to PAH patients compared to controls.\u003cstrong\u003e B) \u003c/strong\u003eFluid boluses given in 24 hours to PAH patients who survived for 30 days compared to PAH patients who died within 30 days.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3980177/v1/11c44159073bc62ba5b9629e.jpg"},{"id":55667641,"identity":"a804684b-0d39-4bdd-9dc7-cc39d8509a48","added_by":"auto","created_at":"2024-05-01 12:11:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1198975,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3980177/v1/e864edcf-1f42-40d9-affa-ba86570d95bd.pdf"},{"id":54321874,"identity":"9d952481-7d95-4321-bff3-600b927ca7f5","added_by":"auto","created_at":"2024-04-08 19:40:19","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":21593,"visible":true,"origin":"","legend":"","description":"","filename":"PAHSepsisSupplement.docx","url":"https://assets-eu.researchsquare.com/files/rs-3980177/v1/2662a3f8fec65f58f99795d3.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Management and Outcomes in Pulmonary Arterial Hypertension Patients with Sepsis","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePulmonary arterial hypertension (PAH) is a disease characterized by pulmonary arterial remodeling leading to increased pulmonary vascular resistance (PVR), right ventricular (RV) dysfunction, and right heart failure.\u003csup\u003e1,2\u003c/sup\u003e Sepsis is the second most common cause of in-hospital death in PAH patients.\u003csup\u003e3\u0026ndash;5\u003c/sup\u003e Recent data suggests that about 25% of patients with PAH who present for sepsis will die while in the hospital.\u003csup\u003e3\u003c/sup\u003e Prompt recognition and treatment of sepsis is vital in the management of this high-risk condition.\u003c/p\u003e \u003cp\u003eSepsis causes numerous systemic changes with adverse effects on the cardiac and pulmonary systems. In sepsis, inflammatory mediators cause systemic vasodilation and capillary permeability, leading to a decrease in systemic vascular resistance (SVR), intravascular hypovolemia, microvascular thrombosis, tissue ischemia, and organ dysfunction. In contrast, PVR is often increased due to upregulated disease mediators such as serotonin, interleukin-6, and endotoxin.\u003csup\u003e6\u0026ndash;10\u003c/sup\u003e A combination of increased metabolic needs due to infection and decreased SVR lead to a demand for markedly increased cardiac output to maintain sufficient mean arterial pressure (MAP) for tissue perfusion. Myocardial contractility and right ventricular contractility may be reduced in sepsis due to modulation of the adrenergic system by cytokines, nitric oxide, bacterial toxins, and damage-associated molecular patterns.\u003csup\u003e11,12\u003c/sup\u003e This effect may be potentiated in septic patients with PAH, who are at increased risk for acute on chronic right ventricular dysfunction and clinical heart failure compared to patients with isolated sepsis.\u003csup\u003e13,14\u003c/sup\u003e In summary, the physiologic effects of sepsis include decreased right ventricular preload, increased right ventricular afterload, and reduced contractility, all in the setting of higher demand for cardiac output.\u003c/p\u003e \u003cp\u003eEach of these factors are further exacerbated in patients with PAH, with unique implications for management. Current management of sepsis in PAH patients includes treating the underlying etiology, optimizing preload, reducing right ventricular afterload, and supporting myocardial function to achieve adequate systemic perfusion.\u003csup\u003e15,16\u003c/sup\u003e Decisions around fluid management are particularly challenging in PAH patients with sepsis. Fluid resuscitation is recommended as part of initial resuscitation to restore preload in septic patients.\u003csup\u003e17\u003c/sup\u003e However, in septic patients with PAH a careful balance between providing fluids to improve preload has to be weighed against the risk of worsening right ventricular dilatation from fluid overload, which paradoxically could be heightened in sepsis due to sepsis-induced increased PVR.\u003csup\u003e10\u003c/sup\u003e Furthermore, differentiating sepsis from other causes of acute on chronic right ventricular dysfunction can be challenging given the relatively non-specific signs used to make an early diagnosis of sepsis. Finally, fluid administration may be complicated by ventricular interdependence, in which a dilated right ventricle causes the interventricular septum to shift towards the left ventricle with a subsequent decrease in left ventricular cardiac output.\u003csup\u003e18,19\u003c/sup\u003e Right ventricular dilatation also increases wall tension and can decrease right ventricular coronary perfusion. This presents a major challenge in the management of sepsis in PAH patients as right ventricular volume overload can lead to impaired cardiac output, with catastrophic implications for both the pulmonary and systemic circulations.\u003csup\u003e16,19\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCurrently, there is little data describing clinical characteristics or treatment strategies for sepsis in this acutely ill population. Guidelines for management of patients with sepsis recommend dynamic reassessment after initial resuscitation, but have not included subsets of patients with pulmonary arterial hypertension.\u003csup\u003e17\u003c/sup\u003e Prior studies show that patients with severe sepsis and septic shock presenting with clinical \u0026ldquo;volume overload\u0026rdquo; are less likely to receive 30 mL/kg crystalloid boluses within 3 hours of sepsis onset.\u003csup\u003e20,21\u003c/sup\u003e While this is associated with higher mortality, delayed hypotension, and increased ICU stay, these studies did not differentiate pulmonary arterial hypertension from other causes of volume overload, such as end-stage renal disease or heart failure with reduced left ventricular systolic function.\u003c/p\u003e \u003cp\u003eCurrent treatment recommendations of PAH patients presenting with sepsis are based on expert opinion rooted in clinical practice or the results of registry or administrative database studies with incompletely characterized cohorts. This retrospective study investigates the treatment approaches and outcomes in a well-characterized cohort of patients with PAH verified by right heart catheterization who presented with sepsis between 2013\u0026ndash;2022, with a particular focus on initial fluid resuscitation.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eWe conducted a retrospective cohort study of patients with PAH, compared to controls without PAH, who all presented for sepsis between 2013 and 2022 at two academic hospitals. PAH patients and controls were adults identified by an automated database search. Sepsis present on admission was identified by ICD-10 diagnosis codes. PAH patients were initially identified by ICD-10 codes for pulmonary arterial hypertension preceding their hospital admission. The specific ICD-10 codes used are listed in the Supplemental. PAH patients were admitted between October 1, 2015 \u0026ndash; February 1, 2021, and controls were admitted between January 1st, 2013 and January 1st, 2022. Controls were enrolled in a 3:1 fashion compared to cases (PAH patients admitted with sepsis).\u003c/p\u003e \u003cp\u003eAfter PAH patients and controls were identified, all subsequent data was obtained via manual chart review. Sepsis was defined as the presence of at least two of four systemic inflammatory response syndrome criteria within 24 hours of admission and a suspected source of infection. PAH patients were excluded for the following: lung and/or heart transplant, current left ventricular assist device, or missing/incomplete right heart catheterization data. Both PAH patients and controls were required to have at least 6 months of follow up data or to have died within 6 months of admission. Additional data obtained through chart review included demographics, vital signs, laboratory values, medications used prior to and during admission, intravenous fluids administered during the first 24 and 48 hours of admission, echocardiogram reports, and right heart catheterization reports. The study was approved by our institutional review board, Office of the Human Research Protection Program (OHRPP) IRB#22\u0026ndash;000226.\u003c/p\u003e\n\u003ch3\u003eOutcomes\u003c/h3\u003e\n\u003cp\u003ePrimary outcomes included mortality during or within 30 days of admission. Secondary outcomes included hospital length of stay, intensive care unit (ICU) length of stay, and mechanical ventilator use during admission.\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSubgroup analyses\u003c/h2\u003e \u003cp\u003ePatients were stratified by mortality during or within 30 days of admission, receipt of fluid resuscitation within 24 hours of admission, and by RV systolic function on pre-admission echocardiogram. Severe sepsis was defined as a lactate\u0026thinsp;\u0026gt;\u0026thinsp;18 mg/dL or presence of acute kidney injury, and septic shock was defined per Sepsis-3 criteria as vasopressor requirements to maintain MAP\u0026thinsp;\u0026gt;\u0026thinsp;65 and a lactate\u0026thinsp;\u0026gt;\u0026thinsp;18 mg/dL.\u003csup\u003e22,23\u003c/sup\u003e Patients were identified who met the Severe Sepsis and Septic Shock Management Bundle (SEP-1) bundle criteria for fluid resuscitation within 3 hours of admission by presenting with initial SBP\u0026thinsp;\u0026lt;\u0026thinsp;90, MAP\u0026thinsp;\u0026lt;\u0026thinsp;65, or lactate\u0026thinsp;\u0026gt;\u0026thinsp;18 mg/dL. Finally, patients were categorized by right heart catheterization data as pre-capillary or mixed pre-post capillary pulmonary hypertension using criteria from the 6th World Health Symposium on Pulmonary Hypertension.\u003csup\u003e24\u003c/sup\u003e Acute kidney injury was defined using Kidney Disease Improving Global Outcomes (KDIGO) criteria.\u003csup\u003e25\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003ePropensity score weighting by age, sex, and Charlson comorbidity index was performed for comparisons between patients and controls. Differences between the groups were evaluated by inverse probability weighted regression adjustments. Clinical characteristics and treatment approaches for PAH patients stratified by mortality, fluid resuscitation, and baseline RV systolic function were summarized. Differences between the PAH subgroups were measured by Kruskal-Wallis and Chi-square tests, as appropriate to the variable distribution. Logistic regression models were generated to determine the relationships between mortality and various predictors, including fluids given, vasopressor use, time to antibiotics, number of prior PAH therapies, mechanical ventilation, kidney injury, lactate levels, and various proxies of right ventricular dysfunction. All models were adjusted for age and Charlson comorbidity indices. P-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant. All statistical analyses were performed with R version 4.0.5. (R Foundation for Statistical Computing, Vienna, Austria).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThere were 70 patients identified by ICD-10 codes as having PAH and sepsis present on admission. Thirty cases were included after verification of PAH and sepsis present on admission (\u003cstrong\u003eFigure 1\u003c/strong\u003e). There were also 96 age and sex-matched controls reviewed. Among PAH patients, the average age was 57.2 years, 80% were female, 50% were white, 80% were on PAH-specific therapy, and 60% had either severe sepsis or septic shock (\u003cstrong\u003eTable 1\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHemodynamic measurements of cases with PAH and sepsis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAmong PAH patients, the most recent right heart catheterization was mean 15.2 months prior to admission, and the most recent echocardiogram was mean 7 months prior to admission (\u003cstrong\u003eTable 2\u003c/strong\u003e). There were 20 patients with pre-capillary pulmonary hypertension, 6 with mixed pre-post capillary hypertension, and 4 categorized as neither but who on chart review had PAH (\u003cstrong\u003eTable 2\u003c/strong\u003e). The mean ± SD pulmonary artery pressure was 42.1 ± 12.0 mmHg, with a pulmonary capillary wedge pressure of 11.9 ± 5.8 mmHg and a pulmonary vascular resistance of 7.0 ± 4.2 Wood Units (WU). The mean cardiac index was 2.9 ± 1.1 L/min/m\u003csup\u003e2\u003c/sup\u003e. The mean left ventricular ejection fraction was 72.1 ± 5.7%, with the majority (66.7%) having normal LV systolic function. There were 13 patients (43.3%) with flattened interventricular septa and 12 patients (40%) with dilated inferior vena cava. There were 14 (46.7%) patients with at least mild RV systolic dysfunction on prior echocardiogram (subgroup analysis included in \u003cstrong\u003eSupplemental Table 1\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTreatment approaches and outcomes\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePAH patients received lower volume intravenous fluids (mean, SD 406.1 ± 590.7 mL v. 1502.7 ± 1482.5 mL at 24 hours, p\u0026lt;0.001) (\u003cstrong\u003eFigure 2\u003c/strong\u003e), and were more likely to receive vasopressors (23.3% v. 8.3% at 24 hours, p=0.037, \u003cstrong\u003eTable 3\u003c/strong\u003e). They also had non-significantly increased hospital lengths of stay (mean ± SD, 31.6 ± 48.5 days v. 17.5 ± 30.7 days, p=0.127), similar likelihood of mechanical ventilation (30% v. 22.9%, p=0.433), and greater mortality within 30 days (23.3% v. 13.5%, p=0.376).\u003c/p\u003e\n\u003cp\u003ePAH patients who died during or within 30 days of admission were older (median, IQR 74 years (67-77.5) vs. 55 years (48.5-59), p=0.017) and had higher Charlson comorbidity indices (6 (5.5-7.5) vs. 4 (2-5.5), p=0.019) compared to those who survived (\u003cstrong\u003eTable 4\u003c/strong\u003e). PAH patients who died were more likely to require high flow nasal cannula within 24 hours of admission (57.1% v. 21.7%, p=0.030). They also had significantly lower heart rates and temperature on admission compared to those who survived. Overall, those who died had similar rates of severe sepsis/septic shock, similar RV systolic function, and similar hemodynamic characteristics by right heart catheterization. They also had similar rates of PAH therapy prior to and during admission, vasopressor use, mechanical ventilation, hospital length of stay, and likelihood of being in the ICU. They had non-statistically significant increased likelihood of AKI present on admission (57.1% v. 26.1%), time to antibiotics (4.5 hours IQR 2.5-7.6 v 2.7 hours IQR 1.3-5.1) (\u003cstrong\u003eTable 4\u003c/strong\u003e), and received less intravenous fluid in the first 24 hours (0 mL IQR 0-125 v. 250 mL IQR 0-900) (\u003cstrong\u003eFigure 2\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eThere were 14 PAH patients who received fluid resuscitation within the first 24 hours, compared to 16 patients who received no fluids (\u003cstrong\u003eTable 5\u003c/strong\u003e). Both groups had similar presenting vitals, laboratory findings, and sepsis severity. Only 28.6% of those who received fluids were on three PH drugs compared to 50% of patients who did not receive fluids, and those who received fluids were less likely to be on parental PH medication (35.7% v. 87.5%, p=0.011), had lower mean pulmonary artery pressures (37 mmHg IQR 27-45 vs. 45.5 mmHg IQR 40-52, p=0.037) and were less likely to have reduced RV systolic function (28.6% v. 62.5%, p=0.136). Those who received fluids had shorter time to antibiotics (2.3 IQR 1.2-4.5 hours vs. 6.5 IQR 2.5-19.1 hours, p=0.041) and were less likely to receive diuretics in the first 48 hours of their hospital stay (35.7% v. 81.2%, p=0.030). They also trended towards resolution of AKI within 48 hours (100% v. 50%) and greater improvement in lactate (median, IQR 6.5 mg/dL (0.8-10.2) v. 5 mg/dL (4-6)). Both groups had similar hospital lengths of stay. Interestingly, only 1 of the patients who received fluids died (7.1%), compared to 6 of the patients who did not receive fluids (37.5%), although this difference was not significant ( p=0.126).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eLogistic Regression Models of Survival Among Patients with Pulmonary Arterial Hypertension Hospitalized for Sepsis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn the logistic regression models, increased fluid resuscitation at 24 hours or 48 hours were both significantly associated with decreased mortality (\u003cstrong\u003eTable 6,\u0026nbsp;\u003c/strong\u003eOR and 95% CI for each 250 mL of fluid given 0.93 (0.84-0.98), p=0.030, and 0.93 (0.84-0.97), p=0.024, respectively).A number of variables were non-significantly associated with higher likelihood of mortality, including vasopressor use, higher number of PH medications used at baseline, reduced RV systolic function, acute kidney injury on presentation, ICU stay during admission, and mechanical ventilation during admission. Time to antibiotics was also not associated with survival.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdditional logistic regression models were generated to identify predictors of receiving intravenous fluid resuscitation (see \u003cstrong\u003eSupplemental Table 2\u003c/strong\u003e). A significant predictor for increased likelihood of receiving fluids was higher initial lactate (OR and 95% CI 1.23 (1.04-1.55,) p=0.049). Impaired RV systolic function on previous echocardiogram also predicted lower likelihood of receiving fluids (OR and 95% CI 0.14, (0.02-0.99), p=0.05).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis retrospective study compared patients presenting with sepsis with and without PAH to characterize clinical presentation, treatment approach, and outcomes, with a focus on fluid resuscitation. The key findings of the present study are 1) PAH patients with sepsis had a high mortality rate of 23.3%, 2) PAH patients received less intravenous fluid resuscitation and were more likely to receive vasopressors than controls, 3) variables associated with increased mortality included age, Charlson comorbidity index, low heart rate, low temperature, and need for high flow nasal cannula within 24 hours of admission, while increased volume of fluid resuscitation in the first 24 hours of admission was associated with lower mortality.\u003c/p\u003e \u003cp\u003ePAH patients had a high mortality rate of 23.3% compared to 13.5% among controls (p\u0026thinsp;=\u0026thinsp;0.376). The lack of statistical difference may be due in part to lack of power, and notably the 23.3% mortality is similar to a large database study demonstrating a mortality rate of 25% in patients with PAH and sepsis.\u003csup\u003e1\u003c/sup\u003e He et al. examined 285 patients with sepsis and PAH and found lower mortality of 16.3%, however these patients may have been less ill, suggested by a lower rate of vasopressor use in both PAH patients and controls (3.1% and 2.3% use, compared to 33.3% and 8.3%, respectively, in this study).\u003csup\u003e14\u003c/sup\u003e Notably, the absolute difference in mortality between PAH patients and controls in our study was about 10% even with propensity score weighting of controls by Charlson comorbidity index. This suggests that PAH may increase mortality risk in sepsis beyond the comorbidity points assigned to heart failure in the index.\u003c/p\u003e \u003cp\u003eIn this study, controls received larger IV fluid volumes within 24 hours, while PAH patients were significantly more likely to receive vasopressors within 24 hours. This suggests a difference in the approach to initial resuscitation in patients with PAH and sepsis compared to patients without PAH. The 2021 Surviving Sepsis Guidelines recommend fluid resuscitation as first line in patients with sepsis and organ hypoperfusion or septic shock, yet PAH patients with hypotension in this study frequently received pressors as the first treatment rather than IV fluid.\u003csup\u003e17\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis difference in management may in part be due to the challenge facing physicians in differentiating sepsis from cardiac decompensation in patients with PAH. While all patients presented with at least two of four SIRS criteria, only about 40% of this cohort had positive blood cultures supporting a definitive infectious etiology. These findings highlight the diagnostic challenge that underlying PAH represents in the setting of organ malperfusion or hypotension, and may complicate the optimal volume management strategy given the risk of RV dysfunction with IV fluid administration.\u003csup\u003e19,26\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWe found that fluid resuscitation may be beneficial in select PAH patients, as increased fluid boluses were associated with lower mortality in our cohort. It is worth noting that two recent randomized controlled trials of patients with severe sepsis or septic shock found no difference in mortality between restrictive or liberal fluid resuscitation strategies.\u003csup\u003e27,28\u003c/sup\u003e However, in both studies patients included only very ill patients with either severe sepsis or septic shock, and considerably more fluids were administered in the restrictive arm (mean 1.27 liters and over 2 liters) than were administered to the PAH patients in the present study (mean 0.41 L), and so their results likely do not generalize to our cohort. In the present study, IV fluids were associated with decreased mortality, non-significantly higher likelihood of resolution of AKI and improvement in lactate levels. Notably, these PAH patients had similar presenting vital signs, brain natriuretic peptide levels, and SEP-1 bundle criteria rates compared to controls. Fluid resuscitation was also associated with significantly early administration of antibiotics, suggesting earlier recognition of sepsis although time to antibiotics was not associated with improved mortality in this cohort.\u003csup\u003e29,30\u003c/sup\u003e PAH patients who did not receive fluids had higher mean pulmonary artery pressures and trended towards greater RV dysfunction on transthoracic echocardiogram, which may have impacted the fluid management strategy and mortality. Analysis of patients with echocardiographic RV dysfunction is included in Supplement 1.\u003c/p\u003e \u003cp\u003eLimitations to this study include its retrospective nature and small sample size. The patients\u0026rsquo; presenting volume status and any beside evaluation of cardiac function were not available. Multiple confounders could underly the finding of increased fluid resuscitation and improved mortality, particularly that patients with worse RV dysfunction may be both less likely to receive IV fluids given concerns of right ventricular dilatation and may also have higher mortality due to their cardiac dysfunction.\u003c/p\u003e \u003cp\u003eTo our knowledge, this is the first study of PAH and sepsis that incorporated right heart catheterization data and chart review to generate a validated, well-characterized cohort of patients with PAH and sepsis. The few published studies on PAH and sepsis used large scale administrative databases or registries and lacked objective confirmation of PAH and sepsis.\u003csup\u003e13,14\u003c/sup\u003e It is notable that our initial database search using ICD-10 codes generated 70 patients identified as having PAH and sepsis on presentation, but that after chart review only 30 patients were found to meet inclusion criteria. Further, while our small sample size was a limitation in terms of statistical power, it also allowed for complete phenotyping of each case.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis was a retrospective study characterizing patients with PAH who presented with sepsis compared to propensity weighted controls without PAH. Patients with underlying PAH had high mortality, received lower volume of fluids during initial resuscitation, and had higher rates of vasopressor use. Among PAH patients, those who received fluid resuscitation had improved mortality and shorter time to antibiotics. These findings reflect the challenges around early fluid resuscitation in PAH patients presenting with sepsis, weighing the risks of precipitating RV decompensation against under-resuscitating a septic patient. These findings also suggest that early identification of sepsis in these patients is critical in shortening time to antibiotics. Further research is needed to help guide decision-making around early fluid management in patients with PAH presenting with sepsis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study was approved by our institutional review board, Office of the Human Research Protection Program (OHRPP) IRB#22-000226.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was used to complete this research.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.F., R.K., S.G., R.S., R.C., and A.S. contributed to the conception and design of the work. S.F. assisted with the data analysis and prepared Figures 1-2. S.F., H.C., A.S., R.K., R.S., R.C., and S.J interpreted the findings and substatntively revised the work. S.F., H.C., and A.S. acquired the data and wrote the main manuscript text. All authors reviewed the manuscript and approved the submitted version.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTrammell AW, Shah AJ, Phillips LS, Michael Hart C. Mortality in US veterans with pulmonary hypertension: a retrospective analysis of survival by subtype and baseline factors. \u003cem\u003ePulm Circ\u003c/em\u003e. 2019;9(1). doi:10.1177/2045894019825763\u003c/li\u003e\n\u003cli\u003eRuopp NF, Cockrill BA. Diagnosis and Treatment of Pulmonary Arterial Hypertension: A Review. \u003cem\u003eJAMA\u003c/em\u003e. 2022;327(14):1379-1391. doi:10.1001/JAMA.2022.4402\u003c/li\u003e\n\u003cli\u003eHarder EM, Small AM, Fares WH. Primary cardiac hospitalizations in pulmonary arterial hypertension: Trends and outcomes from 2001 to 2014. \u003cem\u003eRespir Med\u003c/em\u003e. 2020;161:105850. doi:10.1016/J.RMED.2019.105850\u003c/li\u003e\n\u003cli\u003eKitterman N, Poms A, Miller DP, Lombardi S, Farber HW, Barst RJ. Bloodstream infections in patients with pulmonary arterial hypertension treated with intravenous prostanoids: insights from the REVEAL REGISTRY\u0026reg;. \u003cem\u003eMayo Clin Proc\u003c/em\u003e. 2012;87(9):825-834. doi:10.1016/J.MAYOCP.2012.05.014\u003c/li\u003e\n\u003cli\u003eAryal S, King CS. Critical care of patients with pulmonary arterial hypertension. \u003cem\u003eCurr Opin Pulm Med\u003c/em\u003e. 2020;26(5):414-421. doi:10.1097/MCP.0000000000000713\u003c/li\u003e\n\u003cli\u003eSibbald W, Peters S, Lindsay RM. 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The right ventricle in sepsis. \u003cem\u003eClin Chest Med\u003c/em\u003e. 2008;29(4):661-676. doi:10.1016/J.CCM.2008.07.002\u003c/li\u003e\n\u003cli\u003eKakihana Y, Ito T, Nakahara M, Yamaguchi K, Yasuda T. Sepsis-induced myocardial dysfunction: Pathophysiology and management. \u003cem\u003eJ Intensive Care\u003c/em\u003e. 2016;4(1):1-10. doi:10.1186/S40560-016-0148-1/FIGURES/3\u003c/li\u003e\n\u003cli\u003ePischke SE, Hestenes S, Johansen HT, et al. Sepsis causes right ventricular myocardial inflammation independent of pulmonary hypertension in a porcine sepsis model. \u003cem\u003ePLoS One\u003c/em\u003e. 2019;14(6). doi:10.1371/JOURNAL.PONE.0218624\u003c/li\u003e\n\u003cli\u003eHe W, Zhang W, An Y, Huang L, Luo H. Impact of Pulmonary Arterial Hypertension on Systemic Inflammation, Cardiac Injury and Hemodynamics in Sepsis: A Retrospective Study From MIMIC-III. \u003cem\u003eAm J Med Sci\u003c/em\u003e. 2022;363(4):311-321. doi:10.1016/J.AMJMS.2021.12.009\u003c/li\u003e\n\u003cli\u003eVasudeva R, Challa A, Tuck N, Pothuru S, Vindhyal M. Hospital outcomes for patients with pulmonary arterial hypertension in sepsis and septic shock. \u003cem\u003eBMC Pulm Med\u003c/em\u003e. 2022;22(1):1-6. doi:10.1186/S12890-022-02145-1/TABLES/2\u003c/li\u003e\n\u003cli\u003eChan C, Klinger JR. Sepsis and Pulmonary Arterial Hypertension in the ICU. \u003cem\u003eAdv Pulm Hypertens\u003c/em\u003e. 2015;13(4):188-196. doi:10.21693/1933-088X-13.4.188\u003c/li\u003e\n\u003cli\u003eTartavoulle TM. Management of Sepsis in Patients with Pulmonary Arterial Hypertension in the Intensive Care Unit. \u003cem\u003eCrit Care Nurs Clin North Am\u003c/em\u003e. 2017;29(1):15-23. doi:10.1016/j.cnc.2016.09.003\u003c/li\u003e\n\u003cli\u003eEvans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. \u003cem\u003eIntensive Care Med 2021 4711\u003c/em\u003e. 2021;47(11):1181-1247. doi:10.1007/S00134-021-06506-Y\u003c/li\u003e\n\u003cli\u003eHoeper MM, Granton J. Intensive care unit management of patients with severe pulmonary hypertension and right heart failure. \u003cem\u003eAm J Respir Crit Care Med\u003c/em\u003e. 2011;184(10):1114-1124. doi:10.1164/RCCM.201104-0662CI\u003c/li\u003e\n\u003cli\u003eChan C, Klinger JR. Sepsis and Pulmonary Arterial Hypertension in the ICU. \u003cem\u003eAdv Pulm Hypertens\u003c/em\u003e. 2015;13(4):188-196. doi:10.21693/1933-088x-13.4.188\u003c/li\u003e\n\u003cli\u003eLeisman DE, Goldman C, Doerfler ME, et al. Patterns and Outcomes Associated With Timeliness of Initial Crystalloid Resuscitation in a Prospective Sepsis and Septic Shock Cohort. \u003cem\u003eCrit Care Med\u003c/em\u003e. 2017;45(10):1596-1606. doi:10.1097/CCM.0000000000002574\u003c/li\u003e\n\u003cli\u003eKuttab HI, Lykins JD, Hughes MD, et al. Evaluation and Predictors of Fluid Resuscitation in Patients with Severe Sepsis and Septic Shock. \u003cem\u003eCrit Care Med\u003c/em\u003e. 2019;47(11):1582. doi:10.1097/CCM.0000000000003960\u003c/li\u003e\n\u003cli\u003eSinger M, Deutschman CS, Seymour C, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). \u003cem\u003eJAMA - J Am Med Assoc\u003c/em\u003e. 2016;315(8):801-810. doi:10.1001/jama.2016.0287\u003c/li\u003e\n\u003cli\u003eLevy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. \u003cem\u003eCrit Care Med\u003c/em\u003e. 2003;31(4):1250-1256. doi:10.1097/01.CCM.0000050454.01978.3B\u003c/li\u003e\n\u003cli\u003eSimonneau G, Montani D, Celermajer DS, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. \u003cem\u003eEur Respir J\u003c/em\u003e. 2019;53(1). doi:10.1183/13993003.01913-2018\u003c/li\u003e\n\u003cli\u003eKellum JA, Lameire N, Aspelin P, et al. Diagnosis, evaluation, and management of acute kidney injury: A KDIGO summary (Part 1). \u003cem\u003eCrit Care\u003c/em\u003e. 2013;17(1):1-15. doi:10.1186/CC11454/FIGURES/2\u003c/li\u003e\n\u003cli\u003eMcLaughlin V V., Shah SJ, Souza R, Humbert M. Management of Pulmonary Arterial Hypertension. \u003cem\u003eJ Am Coll Cardiol\u003c/em\u003e. 2015;65(18):1976-1997. doi:10.1016/J.JACC.2015.03.540\u003c/li\u003e\n\u003cli\u003eNI S, IS D, RG B, et al. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. \u003cem\u003eN Engl J Med\u003c/em\u003e. 2023;388(6):499-510. doi:10.1056/NEJMOA2212663\u003c/li\u003e\n\u003cli\u003eCorl KA, Prodromou M, Merchant RC, et al. The Restrictive Intravenous Fluid Trial in Severe Sepsis and Septic Shock (RIFTS): a Randomized Pilot Study. \u003cem\u003eCrit Care Med\u003c/em\u003e. 2019;47(7):951. doi:10.1097/CCM.0000000000003779\u003c/li\u003e\n\u003cli\u003eIm Y, Kang D, Ko RE, et al. Time-to-antibiotics and clinical outcomes in patients with sepsis and septic shock: a prospective nationwide multicenter cohort study. \u003cem\u003eCrit Care\u003c/em\u003e. 2022;26(1):1-10. doi:10.1186/S13054-021-03883-0/FIGURES/4\u003c/li\u003e\n\u003cli\u003ePeltan ID, Brown SM, Bledsoe JR, et al. ED Door-to-Antibiotic Time and Long-term Mortality in Sepsis. \u003cem\u003eChest\u003c/em\u003e. 2019;155(5):938-946. doi:10.1016/J.CHEST.2019.02.008\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1: Demographics and Clinical Characteristics of Patients with Pulmonary Arterial Hypertension Admitted for Sepsis Compared to Propensity-Weighted Controls\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003ePAH patients (n=30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.923076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eControls (n=96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e57.2 \u0026plusmn;\u0026nbsp;16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.923076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e57.6 \u0026plusmn;\u0026nbsp;16.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.361\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eSex, Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e24 (80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.923076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e73 (76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.522\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eRace\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;White\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Black\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Asian\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15 (50%)\u003c/p\u003e\n \u003cp\u003e6(20.0%)\u003c/p\u003e\n \u003cp\u003e1 (3.3%)\u003c/p\u003e\n \u003cp\u003e8 (26.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.923076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e58 (60.4%)\u003c/p\u003e\n \u003cp\u003e5 (5.0%)\u003c/p\u003e\n \u003cp\u003e11 (12.1%)\u003c/p\u003e\n \u003cp\u003e22 (22.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.399\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.031\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.818\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eCharlson comorbidity index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e4.0 \u0026plusmn;\u0026nbsp;2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.923076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e3.9 \u0026plusmn;\u0026nbsp;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.237\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003ePresenting vitals and laboratory data\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; MAP, mmHg\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eRespiratory rate, per minute\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eTemperature, Fahrenheit\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Heart rate, per minute\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; SpO2, %\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; WBC, x10\u003csup\u003e3\u003c/sup\u003e/\u0026micro;L\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Lactate, mg/dL\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eCreatinine, mg/dL\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; BNP, pg/mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e76.2 \u0026plusmn;\u0026nbsp;16.8\u003c/p\u003e\n \u003cp\u003e21.5 \u0026plusmn;\u0026nbsp;5.2\u003c/p\u003e\n \u003cp\u003e98.8 \u0026plusmn;\u0026nbsp;1.7\u003c/p\u003e\n \u003cp\u003e94.7 \u0026plusmn;\u0026nbsp;21.6\u003c/p\u003e\n \u003cp\u003e91.9 \u0026plusmn;\u0026nbsp;7.1\u003c/p\u003e\n \u003cp\u003e9.7 \u0026plusmn;\u0026nbsp;5.3\u003c/p\u003e\n \u003cp\u003e16.7 \u0026plusmn;\u0026nbsp;12.1\u003c/p\u003e\n \u003cp\u003e1.97 \u0026plusmn; 2.08\u003c/p\u003e\n \u003cp\u003e876.4 \u0026plusmn; 727.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.923076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e90.6 \u0026plusmn;\u0026nbsp;16.1\u003c/p\u003e\n \u003cp\u003e20.1 \u0026plusmn;\u0026nbsp;5.7\u003c/p\u003e\n \u003cp\u003e99.1 \u0026plusmn;\u0026nbsp;2.2\u003c/p\u003e\n \u003cp\u003e100.8 \u0026plusmn;\u0026nbsp;21.2\u003c/p\u003e\n \u003cp\u003e95.4 \u0026plusmn;\u0026nbsp;7.2\u003c/p\u003e\n \u003cp\u003e14.2 \u0026plusmn;\u0026nbsp;10.3\u003c/p\u003e\n \u003cp\u003e20.1 \u0026plusmn;\u0026nbsp;18.8\u003c/p\u003e\n \u003cp\u003e1.47 \u0026plusmn; 1.39\u003c/p\u003e\n \u003cp\u003e600.0 \u0026plusmn; 768.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003cp\u003e0.391\u003c/p\u003e\n \u003cp\u003e0.157\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.014\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.191\u003c/p\u003e\n \u003cp\u003e0.127\u003c/p\u003e\n \u003cp\u003e0.139\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eBlood culture, positive at 24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e12 (41.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.923076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e24 (25.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eSepsis category\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Sepsis\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Severe sepsis\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Septic shock\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12 (40%)\u003c/p\u003e\n \u003cp\u003e9 (30%)\u003c/p\u003e\n \u003cp\u003e9 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.923076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e32 (30.2%)\u003c/p\u003e\n \u003cp\u003e59 (61.8%)\u003c/p\u003e\n \u003cp\u003e8 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.372\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eSEP-1 Bundle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e14 (46.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.923076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e34 (35.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.224\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eTime to antibiotics, hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e7.4 \u0026plusmn;\u0026nbsp;5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.923076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e5.0 \u0026plusmn;\u0026nbsp;11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003ePH medication during admission, categorical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e26 (86.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.923076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;N/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eReceived parenteral PH medication during admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e10 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.923076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;N/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eBaseline PH medications used, categorical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e24 (80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.923076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;N/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of baseline PH medications used\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (20%)\u003c/p\u003e\n \u003cp\u003e6 (20%)\u003c/p\u003e\n \u003cp\u003e5 (16.7%)\u003c/p\u003e\n \u003cp\u003e13 (43.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.923076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;N/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eMaximal supplemental oxygen use at 24 hours\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; ETT\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; PPV\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; HFNC\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; NRB\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; NC\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Room air\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e1 (3.3%)\u003c/p\u003e\n \u003cp\u003e10 (33.6%)\u003c/p\u003e\n \u003cp\u003e2 (6.6%)\u003c/p\u003e\n \u003cp\u003e13 (43.3%)\u003c/p\u003e\n \u003cp\u003e4 (13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.923076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (6.3%)\u003c/p\u003e\n \u003cp\u003e4 (4.2%)\u003c/p\u003e\n \u003cp\u003e2 (2.1%)\u003c/p\u003e\n \u003cp\u003e8 (8.3%)\u003c/p\u003e\n \u003cp\u003e31 (32.3%)\u003c/p\u003e\n \u003cp\u003e45 (46.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.012\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.440\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.594\u003c/p\u003e\n \u003cp\u003e0.276\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eAbbreviations:\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eMAP = mean arterial pressure, SpO2 = oxygen saturation, WBC = White blood cell count, BNP = brain natriuretic peptide, PH = pulmonary hypertension, ETT = endotracheal intubation, PPV = positive pressure ventilation, HFNC = high flow nasal cannula, NRB = non-rebreather mask, NC = nasal cannula\u003c/p\u003e\n \u003cp\u003ePAH patients and controls were propensity score weighted by Charlson Comorbidity index, age, and sex.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAll numeric values are reported as mean \u0026plusmn; SD. P-values are from Inverse Probability Weighted Regression Adjustment.\u003c/p\u003e\n \u003cp\u003eAll vital signs and lab values reported are the earliest available values during the qualifying encounter for sepsis. *p\u0026lt;0.05, **p\u0026lt;0.01, ***p\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2: Hemodynamic Measurements Prior to Admission of Patients with Pulmonary Arterial Hypertension\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003eAll PAH patients (n=30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003ePrecapillary PH group (n=20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003eMixed PH group (n=6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003eUncategorized group (n=4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eSex, female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e24 (80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e17 (85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e4 (67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e3 (75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eTime from RHC to admission for sepsis, months\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e15.2\u0026nbsp;\u0026plusmn;\u0026nbsp;16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e11.8 \u0026plusmn;\u0026nbsp;8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e13.8 \u0026plusmn;\u0026nbsp;9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e34.4 \u0026plusmn;\u0026nbsp;40.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eMean RAP, mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e8.9 \u0026plusmn;\u0026nbsp;5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e7.8 \u0026plusmn;\u0026nbsp;4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e14.8 \u0026plusmn;\u0026nbsp;6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e5.5 \u0026plusmn;\u0026nbsp;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eMean PAP, mmhG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e42.1 \u0026plusmn;\u0026nbsp;12.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e41.3 \u0026plusmn;\u0026nbsp;11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e50.6 \u0026plusmn;\u0026nbsp;10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e33.3 \u0026plusmn;\u0026nbsp;7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003ePCWP, mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e11.9 \u0026plusmn;\u0026nbsp;5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e9.3 \u0026plusmn;\u0026nbsp;4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e21.4 \u0026plusmn;\u0026nbsp;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e13 \u0026plusmn;\u0026nbsp;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eCO, thermodilution, L/min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e5.1 \u0026plusmn;\u0026nbsp;2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e4.4 \u0026plusmn;\u0026nbsp;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e4.8 \u0026plusmn;\u0026nbsp;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e9.0 \u0026plusmn;\u0026nbsp;1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eCO, Fick, L/min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e4.6 \u0026plusmn;\u0026nbsp;1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e4.5 \u0026plusmn;\u0026nbsp;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e4.7 \u0026plusmn;\u0026nbsp;0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eCI, thermodilution, L/min/m\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e2.9 \u0026plusmn;\u0026nbsp;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e2.7 \u0026plusmn;\u0026nbsp;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e2.4 \u0026plusmn;\u0026nbsp;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e5.2 \u0026plusmn;\u0026nbsp;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eCI, Fick, L/min/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e2.3 \u0026plusmn;\u0026nbsp;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e2.4 \u0026plusmn;\u0026nbsp;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e2.2 \u0026plusmn;\u0026nbsp;0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003ePVR, WU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e7.0 \u0026plusmn;\u0026nbsp;4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e8.2 \u0026plusmn;\u0026nbsp;4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e6.0 \u0026plusmn;\u0026nbsp;3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e2.2 \u0026plusmn;\u0026nbsp;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eTime from TTE data to admission for sepsis,\u0026nbsp;months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e6.9 \u0026plusmn;\u0026nbsp;11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e4.1 \u0026plusmn;\u0026nbsp;4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e7.5 \u0026plusmn;\u0026nbsp;6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e20.4 \u0026plusmn;\u0026nbsp;27.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eLA size\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Normal\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Enlarged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16 (53.3%)\u003c/p\u003e\n \u003cp\u003e14 (46.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11 (55%)\u003c/p\u003e\n \u003cp\u003e9 (45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (33.3%)\u003c/p\u003e\n \u003cp\u003e4 (66.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (75%)\u003c/p\u003e\n \u003cp\u003e1 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eLVEF, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e72.1 \u0026plusmn;\u0026nbsp;5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e70 \u0026plusmn;\u0026nbsp;8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e73.3 \u0026plusmn;\u0026nbsp;2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e75 (NA)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eLV systolic function\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Normal\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Mildly reduced\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Hyperdynamic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20 (66.7%)\u003c/p\u003e\n \u003cp\u003e1 \u0026nbsp;(3.3%)\u003c/p\u003e\n \u003cp\u003e9 \u0026nbsp;(30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15 (75%)\u003c/p\u003e\n \u003cp\u003e1 (5%)\u003c/p\u003e\n \u003cp\u003e4 (20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (50%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e3 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (50%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e2 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eIV septum description, flattened\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e13 (43.3%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e12 (60%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e1 (16.7%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eIV septum diameter, cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e1.1 \u0026plusmn;\u0026nbsp;0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e1.1 \u0026plusmn;\u0026nbsp;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e1.1 \u0026plusmn;\u0026nbsp;0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e1.2 \u0026plusmn;\u0026nbsp;0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eDiastolic function description\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Normal\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Grade I dysfunction\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Grade II dysfunction\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Not described\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12 (40%)\u003c/p\u003e\n \u003cp\u003e9 (30%)\u003c/p\u003e\n \u003cp\u003e1 (3.3%)\u003c/p\u003e\n \u003cp\u003e8 (26.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (45%)\u003c/p\u003e\n \u003cp\u003e5 \u0026nbsp;(25%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e6 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (16.7%)\u003c/p\u003e\n \u003cp\u003e3 (50%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e2 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (50%)\u003c/p\u003e\n \u003cp\u003e1 (25%)\u003c/p\u003e\n \u003cp\u003e1 (25%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eRV size\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Normal\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Mildly enlarged\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Moderately enlarged\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Severely enlarged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10(33.3%)\u003c/p\u003e\n \u003cp\u003e8 (26.7%)\u003c/p\u003e\n \u003cp\u003e3 (10%)\u003c/p\u003e\n \u003cp\u003e9 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (20%)\u003c/p\u003e\n \u003cp\u003e7 (35%)\u003c/p\u003e\n \u003cp\u003e2 (10%)\u003c/p\u003e\n \u003cp\u003e7 (35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (66.7%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e2 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (50%)\u003c/p\u003e\n \u003cp\u003e1 (25%)\u003c/p\u003e\n \u003cp\u003e1 (25%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eRV systolic function\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Normal\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Mildly reduced\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Moderately reduced\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Severely reduced\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Not commented\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15 (50%)\u003c/p\u003e\n \u003cp\u003e5 (16.7%)\u003c/p\u003e\n \u003cp\u003e3 (10%)\u003c/p\u003e\n \u003cp\u003e6 (20%)\u003c/p\u003e\n \u003cp\u003e1 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (40%)\u003c/p\u003e\n \u003cp\u003e3 (15%)\u003c/p\u003e\n \u003cp\u003e3 (15%)\u003c/p\u003e\n \u003cp\u003e5 (25%)\u003c/p\u003e\n \u003cp\u003e1 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (83.3%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e1 (16.7%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (50%)\u003c/p\u003e\n \u003cp\u003e2 (50%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eTAPSE, cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e1.9 \u0026plusmn;\u0026nbsp;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e1.9 \u0026plusmn;\u0026nbsp;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e1.7 \u0026plusmn; \u0026nbsp;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e2.3 \u0026plusmn;\u0026nbsp;0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eDTI, cm/s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e12.7 \u0026plusmn;\u0026nbsp;2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e12.0 \u0026plusmn;\u0026nbsp;1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e12.3 \u0026plusmn;\u0026nbsp;2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e17.8 \u0026plusmn; \u0026nbsp;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eTricuspid regurgitation description\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Trace\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Mild\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Mild-moderate\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Moderate\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Moderate-severe\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Severe\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Not commented\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (26.7%)\u003c/p\u003e\n \u003cp\u003e6 (20%)\u003c/p\u003e\n \u003cp\u003e5 (16.7%)\u003c/p\u003e\n \u003cp\u003e3 (10%)\u003c/p\u003e\n \u003cp\u003e4 (13.3%)\u003c/p\u003e\n \u003cp\u003e3 (10%)\u003c/p\u003e\n \u003cp\u003e1 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (25%)\u003c/p\u003e\n \u003cp\u003e4 (20%)\u003c/p\u003e\n \u003cp\u003e4 (20%)\u003c/p\u003e\n \u003cp\u003e2 (10%)\u003c/p\u003e\n \u003cp\u003e2 (10%)\u003c/p\u003e\n \u003cp\u003e3 (15%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (16.7%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e1 (16.7%)\u003c/p\u003e\n \u003cp\u003e1 (16.7%)\u003c/p\u003e\n \u003cp\u003e2 (33.3%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e1 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (50%)\u003c/p\u003e\n \u003cp\u003e2 (50%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eTricuspid regurgitation velocity, m/s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e3.6 \u0026plusmn;\u0026nbsp;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e3.6 \u0026plusmn;\u0026nbsp;1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e3.8 \u0026plusmn;\u0026nbsp;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e3.0 \u0026plusmn;\u0026nbsp;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eEstimated RVSP/PASP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e63.4 \u0026plusmn;\u0026nbsp;28.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e66.1 \u0026plusmn;\u0026nbsp;29.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e71 \u0026plusmn;\u0026nbsp;23.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e36.7 \u0026plusmn;\u0026nbsp;14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eIVC dilated, yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e12 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e9 (45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e2 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e1 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003eIVC respiratory change, \u0026lt;50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e19 (63.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e12 (60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e6 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e1 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.155339805825243%\" valign=\"top\"\u003e\n \u003cp\u003ePericardial effusion\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; None or trace\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Small\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Moderate\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Large\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.34304207119741%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e25 (83.3%)\u003c/p\u003e\n \u003cp\u003e2 (6.7%)\u003c/p\u003e\n \u003cp\u003e2 (6.7%)\u003c/p\u003e\n \u003cp\u003e1 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.168284789644012%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17 (85%)\u003c/p\u003e\n \u003cp\u003e1 (5%)\u003c/p\u003e\n \u003cp\u003e1 (5%)\u003c/p\u003e\n \u003cp\u003e1 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15210355987055%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (66.7%)\u003c/p\u003e\n \u003cp\u003e1 (13.3%)\u003c/p\u003e\n \u003cp\u003e1 (13.3%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.181229773462782%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (100%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eAbbreviations:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eRHC = right heart catheterization, RAP = right atrial pressure, PAP = pulmonary artery pressure, PCWP = pulmonary capillary wedge pressure, CO = cardiac output, CI = cardiac index, PVR = pulmonary vascular resistance, WU = Wood units\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003eLA = left atrium, LVEF = left ventricular ejection fraction, IV = interventricular, RV = right ventricle, TAPSE = tricuspid annular plane systolic excursion, DTI =doppler tissue echocardiography, RVSP/PASP = right ventricular systolic pressure/pulmonary artery systolic pressure, IVC = inferior vena cava. \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003eAll numeric variables are mean\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u0026plusmn; \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eSD unless otherwise indicated. \u003cstrong\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/strong\u003eHemodynamic categories were defined by World Health Symposium on Pulmonary Hypertension criteria: precapillary is mPAP\u0026gt;20mmHG, PCWP\u0026le;15mmHG, and PVR\u0026ge;3WU. Mixed is mPAP\u0026gt;20mmHG, PCWP\u0026gt;15, PVR\u0026ge;3WU. Uncategorized has hemodynamic values that do not fall into any group.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3: Treatment Approaches and Outcomes in Pulmonary Arterial Hypertension Patients Admitted for Sepsis Compared to Controls\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.506410256410255%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eAll PAH patients (n=30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003eControls\u003c/p\u003e\n \u003cp\u003e(n=96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003ePrecapillary PH group (n=20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.064102564102564%\" valign=\"top\"\u003e\n \u003cp\u003eMixed PH group (n=6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.185897435897434%\" valign=\"top\"\u003e\n \u003cp\u003eUncategorized group (n=4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.506410256410255%\" valign=\"top\"\u003e\n \u003cp\u003eIV fluid boluses in first 24 hours, mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e406.1 \u0026plusmn;\u0026nbsp;590.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e1502.7 \u0026plusmn;\u0026nbsp;1482.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e443.7 \u0026plusmn;\u0026nbsp;720\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.064102564102564%\" valign=\"top\"\u003e\n \u003cp\u003e371.7 \u0026plusmn;\u0026nbsp;670.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.185897435897434%\" valign=\"top\"\u003e\n \u003cp\u003e171.5 \u0026plusmn;\u0026nbsp;382.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.506410256410255%\" valign=\"top\"\u003e\n \u003cp\u003eIV fluid boluses in first 48 hours, mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e563.0 \u0026plusmn;\u0026nbsp;766.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e2232.4 \u0026plusmn;\u003c/p\u003e\n \u003cp\u003e3930.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e581.4 \u0026plusmn; \u0026nbsp;951.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.064102564102564%\" valign=\"top\"\u003e\n \u003cp\u003e371.7 \u0026plusmn;\u003c/p\u003e\n \u003cp\u003e670.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.185897435897434%\" valign=\"top\"\u003e\n \u003cp\u003e853.2 \u0026plusmn;\u0026nbsp;865.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.506410256410255%\" valign=\"top\"\u003e\n \u003cp\u003eVasopressor use in first 24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e7 (23.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e8 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.037\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e5 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.064102564102564%\" valign=\"top\"\u003e\n \u003cp\u003e2 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.185897435897434%\" valign=\"top\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.506410256410255%\" valign=\"top\"\u003e\n \u003cp\u003eVasopressor use in first 48 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e10 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e8 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e7 (35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.064102564102564%\" valign=\"top\"\u003e\n \u003cp\u003e3 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.185897435897434%\" valign=\"top\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.506410256410255%\" valign=\"top\"\u003e\n \u003cp\u003eHospital length of stay, days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e31.6 \u0026plusmn;\u0026nbsp;48.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e17.5 \u0026plusmn;\u0026nbsp;30.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e37.7 \u0026plusmn;\u0026nbsp;65.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.064102564102564%\" valign=\"top\"\u003e\n \u003cp\u003e17.2 \u0026plusmn;\u0026nbsp;17.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.185897435897434%\" valign=\"top\"\u003e\n \u003cp\u003e15.8 \u0026plusmn;\u0026nbsp;24.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.506410256410255%\" valign=\"top\"\u003e\n \u003cp\u003eMechanical ventilation during admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e9 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e22 (22.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e0.433\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e6 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.064102564102564%\" valign=\"top\"\u003e\n \u003cp\u003e2 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.185897435897434%\" valign=\"top\"\u003e\n \u003cp\u003e1 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.506410256410255%\" valign=\"top\"\u003e\n \u003cp\u003eMortality during admission or within 30 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e7 (23.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e13 (13.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.820512820512821%\" valign=\"top\"\u003e\n \u003cp\u003e0.376\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.461538461538462%\" valign=\"top\"\u003e\n \u003cp\u003e3 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.064102564102564%\" valign=\"top\"\u003e\n \u003cp\u003e3 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.185897435897434%\" valign=\"top\"\u003e\n \u003cp\u003e1 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eAbbreviations:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eIV = intravenous, PH = pulmonary hypertension\u003c/p\u003e\n \u003cp\u003ePAH patients and controls were propensity score weighted by Charlson Comorbidity index, age, and sex.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAll numeric variables are mean\u0026nbsp;\u0026plusmn;\u0026nbsp;SD unless otherwise indicated. P-values are from Inverse Probability Weighted Regression Adjustment.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 4: Characteristics and Treatment Approaches of Patients with Pulmonary Arterial Hypertension Admitted for Sepsis by Mortality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003eAlive (n=23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003eDeceased (n=7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e55 (48.5-59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e74 (67-77.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.017\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eSex, female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e19 (82.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e5 (71.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.914\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eRace\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;White\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Black\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Asian\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003eWhite 9 (39.1%)\u003c/p\u003e\n \u003cp\u003eBlack 6 (26.1%)\u003c/p\u003e\n \u003cp\u003eOther 7 (30.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003eWhite 6 (85.7%)\u003c/p\u003e\n \u003cp\u003eBlack 1 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.166\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eCharlson comorbidity index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e4 (2-5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e6 (5.5-7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003ePresenting vitals and laboratory data\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; MAP, mmHg\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eRespiratory rate, per minute\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eTemperature, Fahrenheit\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Heart rate, per minute\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; SpO2, %\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; WBC, x10\u003csup\u003e3\u003c/sup\u003e/\u0026micro;L\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Serum lactate, mg/dL\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; BNP, pg/mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e74.7 (66.8-88.3)\u003c/p\u003e\n \u003cp\u003e20 (18-25)\u003c/p\u003e\n \u003cp\u003e98.5 (98-100.5)\u003c/p\u003e\n \u003cp\u003e103 (88.5-110.5)\u003c/p\u003e\n \u003cp\u003e95 (92.5-96)\u003c/p\u003e\n \u003cp\u003e7.1 (6-11.3)\u003c/p\u003e\n \u003cp\u003e13 (8-19.5)\u003c/p\u003e\n \u003cp\u003e494 (223.2-1265.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e68 (62.8-79.7)\u003c/p\u003e\n \u003cp\u003e18 (17-19)\u003c/p\u003e\n \u003cp\u003e97.5 (97.3-97.9)\u003c/p\u003e\n \u003cp\u003e74 (68-85.5)\u003c/p\u003e\n \u003cp\u003e90 (87-94.5)\u003c/p\u003e\n \u003cp\u003e11.1 (10.1-12.7)\u003c/p\u003e\n \u003cp\u003e14 (10-16.5)\u003c/p\u003e\n \u003cp\u003e890 (356.5-1378.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.249\u003c/p\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.013\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.209\u003c/p\u003e\n \u003cp\u003e0.249\u003c/p\u003e\n \u003cp\u003e0.702\u003c/p\u003e\n \u003cp\u003e0.619\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eBlood culture, positive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e7 (30.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e2 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.349\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eSepsis category\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Sepsis\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Severe sepsis\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Septic shock\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.668\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eSEP-1 Bundle criteria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e11 (47.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e3 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003ePH medication during admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e19 (82.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e7 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.582\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eReceived parenteral PH medication during admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e14 (60.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e5 (71.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.952\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eBaseline PH medication use, yes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e18 (78.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e7 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.440\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of baseline PH medications used\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (21.7%)\u003c/p\u003e\n \u003cp\u003e1 (17.4%)\u003c/p\u003e\n \u003cp\u003e2 (17.4%)\u003c/p\u003e\n \u003cp\u003e3 (43.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e3 (42.9%)\u003c/p\u003e\n \u003cp\u003e2 (28.6%)\u003c/p\u003e\n \u003cp\u003e2 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.302\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eSupplemental oxygen use at 24 hours\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;None\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;NC\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;NRB\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;HFNC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (17.4%)\u003c/p\u003e\n \u003cp\u003e13 (56.5%)\u003c/p\u003e\n \u003cp\u003e1 (4.3%)\u003c/p\u003e\n \u003cp\u003e5 (21.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003cp\u003e2 (14.3%)\u003c/p\u003e\n \u003cp\u003e1 (14.3%)\u003c/p\u003e\n \u003cp\u003e4 (57.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.030\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eTime to antibiotics, hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e2.7 (1.3-5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e4.5 (2.5-7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.441\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003ePCWP, mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e11 (8-14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e12 (8.5-14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.459\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eMean RAP, mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e7 (5-12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e10 (8.5-10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.403\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eMean PAP, mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e41 (32-49.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e45 (40-48.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.556\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003ePVR, WU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e7.8 (3.3-9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e5.8 (4.2-6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.351\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eCI, thermodilution, L/min/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e2.6 (2.1-3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e2.9 (2.9-3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.301\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eRV systolic function reduced\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e11 (47.8%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e3 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eChange in lactate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e-5.5 (-9.2, -0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e-7 (-26, -7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.148\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eChange in creatinine, 24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e-0.1 (-0.2-0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e-0.1 (-0.9-0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.683\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eAKI present on admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e6 (26.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e4 (57.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.146\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eAKI resolved by 48 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e6 (27.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e2 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.395\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eMechanical ventilation used during admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e7 (30.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e2 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eIV fluid boluses in first 24 hours, mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e250 (0-900)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0-125)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eIV fluid boluses in first 48 hours, mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e250 (0-1500)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0-400)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.183\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eDiuretic use in first 24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e10 (43.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e4 (57.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.840\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eDiuretic use in first 48 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e14 (60.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e4 (57.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eVasopressor use in first 24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e5 (21.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e2 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eVasopressor use in first 48 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e8 (34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e2 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eHospital length of stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e15 (8-38.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e11 (7.5-20.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.628\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eICU stay during admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e14 (60.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e4 (57.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eICU length of stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e23.5 (13.5-30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e21 (11-59.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eAbbreviations:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eMAP = mean arterial pressure, SpO2 = oxygen saturation, WBC = White blood cell count, RAP = right atrial pressure, PAP = pulmonary artery pressure, PCWP = pulmonary capillary wedge pressure, CI = cardiac index, PVR = pulmonary vascular resistance, WU = Wood units, ICU = intensive care unit.\u003c/p\u003e\n \u003cp\u003eAll vital signs and lab values reported are the earliest available values during the qualifying encounter for sepsis.\u003c/p\u003e\n \u003cp\u003eAll numeric values are reported as median (IQR) and p-values are from Kruskal-Wallis tests. *p\u0026lt;0.05, **p\u0026lt;0.01, ***p\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 5: Clinical Characteristics and Treatment Approaches by Fluid Administration within 24 Hours\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003eNo Fluids (n=16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003eReceived Fluids (n=14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e58 (52.8-67.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e57.5 (47-73.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.901\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eSex, female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e13 (81.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e11 (78.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eRace\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;White\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Black\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Asian\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (50%)\u003c/p\u003e\n \u003cp\u003e3 (18.8%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e5 (31.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7 (50%)\u003c/p\u003e\n \u003cp\u003e4 (28.6%)\u003c/p\u003e\n \u003cp\u003e1 (7.1%)\u003c/p\u003e\n \u003cp\u003e2 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.499\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eCharlson comorbidity index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e4 (2-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e5 (2.2-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.659\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003ePresenting vitals and laboratory data\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; MAP, mmHg\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eRespiratory rate, per minute\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eTemperature, Fahrenheit\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Heart rate, per minute\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; SpO2, %\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; WBC, x10\u003csup\u003e3\u003c/sup\u003e/\u0026micro;L\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Serum lactate, mg/dL\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; BNP, pg/mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e72 (66.3-85.6)\u003c/p\u003e\n \u003cp\u003e20 (17.5-22.5)\u003c/p\u003e\n \u003cp\u003e98 (97.7-98.6)\u003c/p\u003e\n \u003cp\u003e91.5 (78.5-104.2)\u003c/p\u003e\n \u003cp\u003e94 (88.5-95.2)\u003c/p\u003e\n \u003cp\u003e9.2 (5.7-11.1)\u003c/p\u003e\n \u003cp\u003e11.5 (9-14.2)\u003c/p\u003e\n \u003cp\u003e561 (347-1332.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e73.5 (66-84.7)\u003c/p\u003e\n \u003cp\u003e18.5 (18-23.8)\u003c/p\u003e\n \u003cp\u003e98.7 (98.1-101.2)\u003c/p\u003e\n \u003cp\u003e103.5 (83-110.8)\u003c/p\u003e\n \u003cp\u003e94.5 (93-96)\u003c/p\u003e\n \u003cp\u003e8.6 (6.2-14.1)\u003c/p\u003e\n \u003cp\u003e18 (8-23)\u003c/p\u003e\n \u003cp\u003e509 (216.5-1180.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.950\u003c/p\u003e\n \u003cp\u003e0.983\u003c/p\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003cp\u003e0.270\u003c/p\u003e\n \u003cp\u003e0.452\u003c/p\u003e\n \u003cp\u003e0.280\u003c/p\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003cp\u003e0.626\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eBlood culture, positive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e6 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e3 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eSepsis category\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Sepsis\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Severe sepsis\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Septic shock\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (50%)\u003c/p\u003e\n \u003cp\u003e3 (18.8%)\u003c/p\u003e\n \u003cp\u003e5 (31.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (28.6%)\u003c/p\u003e\n \u003cp\u003e6 (42.9%)\u003c/p\u003e\n \u003cp\u003e4 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.313\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eSEP-1 Bundle criteria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e8 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e6 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.980\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003ePH medication during admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e15 (93.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e11 (78.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.495\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eReceived parenteral PH medication during admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e14 (87.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e5 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eBaseline PH medication use, yes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e15 (93.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e10 (71.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.252\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of baseline PH medications used\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026shy;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (6.2%)\u003c/p\u003e\n \u003cp\u003e4 (25%)\u003c/p\u003e\n \u003cp\u003e3 (18.8%)\u003c/p\u003e\n \u003cp\u003e8 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (28.6%)\u003c/p\u003e\n \u003cp\u003e3 (21.4%)\u003c/p\u003e\n \u003cp\u003e3 (21.4%)\u003c/p\u003e\n \u003cp\u003e4 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.368\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eSupplemental oxygen use at 24 hours\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;None\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;NC\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;NRB\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;HFNC\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;PPV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (12.5%)\u003c/p\u003e\n \u003cp\u003e5 (31.2%)\u003c/p\u003e\n \u003cp\u003e1 (6.2%)\u003c/p\u003e\n \u003cp\u003e7 (43.8%)\u003c/p\u003e\n \u003cp\u003e1 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (14.3%)\u003c/p\u003e\n \u003cp\u003e9 (64.3%)\u003c/p\u003e\n \u003cp\u003e1 (7.1%)\u003c/p\u003e\n \u003cp\u003e2 (14.3%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.235\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eTime to antibiotics, hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e6.5 (2.5-19.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e2.3 (1.2-4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.041\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eMost recent RHC findings, \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; PCWP, mmHg\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Mean RAP, mmHg\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Mean PAP, mmHG\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; PVR, WU\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; CI, thermodilution, L/min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13 (10.5-14.5)\u003c/p\u003e\n \u003cp\u003e8.5 (5-12.5)\u003c/p\u003e\n \u003cp\u003e45.5 (40-52)\u003c/p\u003e\n \u003cp\u003e7.9 (4.3-10.1)\u003c/p\u003e\n \u003cp\u003e2.8 (2.2-3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9.5 (7.2-13.8)\u003c/p\u003e\n \u003cp\u003e7.5 (5.2-10.8)\u003c/p\u003e\n \u003cp\u003e37 (27-45)\u003c/p\u003e\n \u003cp\u003e4.7 (3.4-8.2)\u003c/p\u003e\n \u003cp\u003e2.9 (2.3-3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.265\u003c/p\u003e\n \u003cp\u003e0.602\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.037\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.270\u003c/p\u003e\n \u003cp\u003e0.982\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eTAPSE, cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e1.8 (1.8-2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e2.2 (1.8-2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eRV systolic function\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Normal\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Mildly reduced\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Moderately reduced\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Severely reduced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (37.5%)\u003c/p\u003e\n \u003cp\u003e3 (18.8%)\u003c/p\u003e\n \u003cp\u003e2 (12.5%)\u003c/p\u003e\n \u003cp\u003e5 (31.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (64.3%)\u003c/p\u003e\n \u003cp\u003e2 (14.2%)\u003c/p\u003e\n \u003cp\u003e1 (7.1%)\u003c/p\u003e\n \u003cp\u003e1 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.464\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eRV systolic function reduced\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e10 (62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e4 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eChange in lactate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e-5 (-6, -4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e-6.5 (-10.2, -0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.613\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eChange in creatinine at 24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e-0.1 (-0.2, 0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e0.0 (-0.3, 0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.539\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eAKI present on admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e4 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e6 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.560\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eResolution of AKI present on admission within 48 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e2 (13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e6 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eDTI, cm/sec\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e11.1 (11-14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e12.9 (10.8-15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.825\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eMechanical ventilation used during admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e4 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e5 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.811\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eIV fluid boluses in first 24 hours, mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e775 (512.5-1375.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eIV fluid boluses in first 48 hours, mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0-0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e1025 (512.5-1518.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eDiuretic use in first 24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e9 (56.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e5 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.448\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eDiuretic use in first 48 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e13 (81.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e5 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.030\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eVasopressor use in first 24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e4 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e3 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eVasopressor use in first 48 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e7 (43.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e3 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.365\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eHospital length of stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e16 (11-36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e9 (7-29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.304\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eICU stay during admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e11 (68.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e7 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e0.501\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eICU length of stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e22 (12-30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.96153846153846%\" valign=\"top\"\u003e\n \u003cp\u003e25 (13-33.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eAbbreviations:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eMAP = mean arterial pressure, SpO2 = oxygen saturation, WBC = White blood cell count, RAP = right atrial pressure, PAP = pulmonary artery pressure, PCWP = pulmonary capillary wedge pressure, CI = cardiac index, PVR = pulmonary vascular resistance, WU = Wood units\u003c/p\u003e\n \u003cp\u003eAll vital signs and lab values reported are the earliest available values during the qualifying encounter for sepsis.\u003c/p\u003e\n \u003cp\u003eAll numeric values are reported as median (IQR) and p-values are from Kruskal-Wallis tests. *p\u0026lt;0.05, **p\u0026lt;0.01, ***p\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 6: Logistics Regression of Survival Among Patients with Pulmonary Arterial Hypertension Hospitalized for Sepsis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.95539033457249%\" valign=\"top\"\u003e\n \u003cp\u003eQuantity fluid boluses given at 24 hours,\u0026nbsp;per 250 cc\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.04460966542751%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.93 (0.84-0.98), p=0.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.95539033457249%\" valign=\"top\"\u003e\n \u003cp\u003eQuantity fluid boluses given at 48 hours, per 250 cc\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.04460966542751%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.93 (0.84-0.97), p=0.024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.95539033457249%\" valign=\"top\"\u003e\n \u003cp\u003eVasopressor use at 24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.04460966542751%\" valign=\"top\"\u003e\n \u003cp\u003e55.3 (1.5-10989), p=0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.95539033457249%\" valign=\"top\"\u003e\n \u003cp\u003eVasopressor use at 48 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.04460966542751%\" valign=\"top\"\u003e\n \u003cp\u003e4.47 (0.32-116), p=0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.95539033457249%\" valign=\"top\"\u003e\n \u003cp\u003ePH medication use at baseline, ordinal of 0, 1, 2, or \u0026gt;=3 medications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.04460966542751%\" valign=\"top\"\u003e\n \u003cp\u003e3.84 (0.85-48.26), p=0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.95539033457249%\" valign=\"top\"\u003e\n \u003cp\u003eTime to antibiotics, hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.04460966542751%\" valign=\"top\"\u003e\n \u003cp\u003e1.02 (0.83-1.18), p=0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.95539033457249%\" valign=\"top\"\u003e\n \u003cp\u003eMechanical ventilation during admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.04460966542751%\" valign=\"top\"\u003e\n \u003cp\u003e2.25 (0.17-31.71), p=0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.95539033457249%\" valign=\"top\"\u003e\n \u003cp\u003eTAPSE, continuous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.04460966542751%\" valign=\"top\"\u003e\n \u003cp\u003e4.42 (0.12-703), p=0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.95539033457249%\" valign=\"top\"\u003e\n \u003cp\u003eRV systolic function at least mildly impaired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.04460966542751%\" valign=\"top\"\u003e\n \u003cp\u003e1.80 (0.16-25.0), p=0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.95539033457249%\" valign=\"top\"\u003e\n \u003cp\u003eAKI on presentation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.04460966542751%\" valign=\"top\"\u003e\n \u003cp\u003e3.63 (0.34-51.7), p=0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.95539033457249%\" valign=\"top\"\u003e\n \u003cp\u003eICU stay during admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.04460966542751%\" valign=\"top\"\u003e\n \u003cp\u003e3.24 (0.38-48.1), p=0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eAbbreviations:\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eTAPSE = tricuspid annular plane systolic excursion, RV = right ventricle, DTI =doppler tissue echocardiography\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAll values reported are odds ratios generated from logistic regression analyses adjusted for age, sex, and Charlson Comorbidity Index at admission.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"pulmonary arterial hypertension, sepsis, fluid resuscitation","lastPublishedDoi":"10.21203/rs.3.rs-3980177/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3980177/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eINTRODUCTION: \u003c/strong\u003eSepsis is a common cause of death in patients with pulmonary arterial hypertension (PAH). Treatment requires careful fluid management and hemodynamic support. This study compares patients with or without PAH presenting with sepsis with a focus on initial fluid resuscitation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMETHODS:\u003c/strong\u003e This retrospective analysis compared adults with and without PAH admitted for sepsis at two academic hospitals between 2013-2022. Prior PAH diagnosis was verified by review of right heart catheterization data and sepsis present on admission was verified by chart review. Demographics, vital signs, laboratory values, imaging results, treatment approaches, and all-cause mortality data were obtained. Controls were propensity score weighted by age, sex, and Charlson Comorbidity index. Logistic regression models controlling for age and Charlson comorbidity indices were used to examine factors associated with survival.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS: \u003c/strong\u003eThirty patients admitted for sepsis with pre-existing PAH were compared to 96 matched controls. Controls received significantly more fluids at 24 hours compared to PAH patients (mean 1503 mL v. 406 mL, p\u0026lt;0.001), while PAH patients were more likely to receive vasoactive medications (23.3% vs. 8.3%, p=0.037). At 30 days, 7 PAH patients (23.3%) and 13 control patients (13.5%) had died (p=0.376). PAH patients that received more fluids had decreased mortality (OR 0.93, 95% CI 0.84-0.98, p=0.03) and patients who received fluids had shorter mean time to antibiotics (2.3 hours v. 6.5 hours, p=0.04), although decreased time to antibiotics was not associated with mortality. Patients who received no fluids more often had previously identified right ventricular systolic dysfunction (62.5% v. 28.6%, p=0.136).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSION: \u003c/strong\u003ePatients with PAH and sepsis have high mortality and receive different treatments than controls, with more reliance on vasopressors and less on fluid resuscitation. PAH patients who received less fluids had higher mortality and those who received no fluids had a longer time to receiving antibiotics, indicating a potential delay in recognizing sepsis. Timely recognition of sepsis and dynamic decision-making around fluid resuscitation remains critical in this high-risk population.\u003c/p\u003e","manuscriptTitle":"Management and Outcomes in Pulmonary Arterial Hypertension Patients with Sepsis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-08 19:40:14","doi":"10.21203/rs.3.rs-3980177/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b5c53eb3-5963-4984-b722-71eeda886a49","owner":[],"postedDate":"April 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-31T11:21:38+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-08 19:40:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3980177","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3980177","identity":"rs-3980177","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}