Abstract Background Myxedema crisis (MC) is a rare and potentially fatal outcome of severe hypothyroidism, marked by hypothermia, hypoventilation, and cardiovascular deterioration. Clinicians may be unaware of its rapidly advancing cardiopulmonary complications due to its rarity. Pulmonary hypertension (PH), characterized by chronically elevated pulmonary vascular resistance and right ventricular strain, can worsen patient instability by reducing hemodynamic capacity and oxygen delivery. A combination of these two diseases creates a high-risk situation for respiratory failure, circulatory dysfunction, and mortality. Understanding the influence of PH in myxedema episodes helps clinicians anticipate deterioration, facilitate decision-making, and recognize this rare endocrine emergency. Methods Using the 2019-2022 National Inpatient Sample (NIS), adults hospitalized with MC were identified using ICD-10 codes. Patients were stratified by the presence of PH. Weighted analyses were performed to estimate national outcomes. The primary outcome was in-hospital mortality. Secondary outcomes included mechanical ventilation (MV), acute respiratory failure, ventricular arrhythmias, cardiogenic shock, pericardial effusion/tamponade, acute congestive heart failure (CHF), cardiac arrest, and acute myocardial infarction (MI). Using both univariate and multivariate analyses, we compared the odds of various in-hospital outcomes and adjusted for confounders. Results Among 1, 138 hospitalizations (weighted ≈ 5. 7 million encounters), patients with PH had higher mortality compared with those without PH (adjusted odds ratio aOR 3. 17, 95% confidence interval CI 1. 71-5. 87). Patients with PH were more likely to need mechanical ventilation (aOR 2. 01, 95% CI 1. 11-3. 66). There were higher rates of acute respiratory failure (aOR 2. 08, 95% CI 1. 22-3. 54), as well as cardiac arrest (aOR 3. 29, 95% CI 1. 33-8. 13), in the PH group. The frequencies of ventricular arrhythmias, pericardial effusion or tamponade, cardiogenic shock, acute congestive heart failure, and acute myocardial infarction were numerically higher but did not reach statistical significance. Adjusted analyses for utilization outcomes showed no measurable difference in length of stay (β = -0. 80 days, p = 0. 47) or total hospital charges (β = -57, p = 0. 996) between groups. Conclusion The presence of PH in patients hospitalized with MC distinguished a subgroup with significantly poorer clinical outcomes, including increased mortality and cardiopulmonary complications. These findings highlight the vulnerability of patients with both endocrine and pulmonary vascular dysfunction. Clinicians should be aware of respiratory decompensation and cardiac instability when managing MC, with an emphasis on early hemodynamic evaluation and interdisciplinary care. Future studies are needed to determine whether earlier identification or targeted management strategies can improve outcomes in this high-risk population. This abstract is funded by: None
Taha et al. (Fri,) studied this question.