Assessing risk factors for the development of pulmonary hypertension in patients with myeloproliferative neoplasms: A meta-analysis and meta-regression.

Abstract

e18594 Background: Myeloproliferative neoplasms (MPN) are widely prevalent hematological malignancies, associated with a poor prognosis and often occur in the elderly with multiple comorbidities. The development of pulmonary hypertension (PH) in these patients further worsens prognosis and heralds a poor outcome. This study aims to assess baseline risk factors contributing to the development of PH in patients with MPN. Methods: A comprehensive literature search was conducted across 5 databases to identify primary studies evaluating baseline parameters of MPN patients with PH vs no-PH. Prevalence of PHT was analyzed using a binomial model (generalized linear mixed model with logit transformation), and a mixed-effects logistic regression model was used to re-assess prevalence accounting for heterogeneity. Furthermore, a risk model was developed to identify factors associated with PH prevalence using logistic regression. Results: A total of 23 studies comprising 1,691 patients with MPN were included for further analysis. Of these, 387 patients had PH, at a prevalence of 22.88%. From the binomial model, a common-effects model revealed a pooled prevalence of 23%[0.21, 0.25]. Due to the significant heterogeneity (I2=92.5%, p<0.0001), a mixed-effect logistic model was implemented, which found a prevalence of 28%[0.16, 0.45]. Factors accounting for the significant heterogeneity were further assessed in the risk model, which included the age of PH patients, and disease duration. Longer disease duration was positively correlated with increased odds of PH in MPN patients (r-squared, 0.23; SE, 0.07, p=0.0008). However, global age across all MPN patients was associated with positive odds of PH (r-squared, 0.95; SE, 0.12; p<0.0001). Conclusions: The analysis revealed an average prevalence of PH among MPN patients to be 28% across reported studies, thus making up almost one-fifth of all patients. Age of MPN patients was significantly associated with higher odds of PH, implying age to be a significant risk factor. This, coupled with the development of other comorbidities, could accelerate the rise in pulmonary arterial pressure. Additionally, disease duration significantly predicted PH, thus implying the setting-in of pathological processes further worsening pulmonary vasculature as the disease progresses. Further research needs to be conducted to assess serum-based risk factors, and to comparatively assess outcomes in patients with PH-MPN vis-a-vis those without.