ORIGINAL RESEARCH article
Front. Med.
Sec. Pulmonary Medicine
This article is part of the Research TopicBridging Respiratory Health and Systemic Disease through Environmental and Infectious InteractionsView all articles
Clinical and prognostic significance of various anaemia types in pulmonary arterial hypertension
Provisionally accepted
Marcin Waligóra1,2,3
Maria Mrowicka1
Miłosz Pietrus4Justyna Daniek1Patrycja Kurczyna1Michał Karnaś1Weronika Chaba1Kamil Jonas1,2,3
Grzegorz Kopec1,2*- 1Pulmonary Circulation Centre Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Krakow, Poland, Kraków, Poland
- 2Department of Cardiac and Vascular Diseases, St. John Paul II Hospital, Krakow, Poland, Kraków, Poland
- 3Center for Innovative Medical Education, Department of Medical Education, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland, Kraków, Poland
- 4Department of Gynecology and Oncology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland, Kraków, Poland
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Introduction: Current risk models for pulmonary arterial hypertension (PAH) omit anaemia, although it may aggravate symptoms and haemodynamics. We assessed whether anaemia and its subtypes add prognostic value. Methods: This study included patients with idiopathic (IPAH) or connective tissue disease-associated PAH (CTD-PAH). Anaemia was classified per WHO criteria into four subtypes: anaemia of chronic disease (ACD), iron deficiency anaemia (IDA), ACD/IDA overlap, and multifactorial anaemia. Risk stratification followed the ESC 2022 guidelines and was reassessed after 12 months. Results: Among 127 patients (78.7% IPAH, 21.3% CTD-PAH) anaemia was present in 22 patients (17.3%), including ACD (31.8%), ACD/IDA overlap (27.3%), and multifactorial anaemia (40.9%). Patients with anaemia had higher baseline risk strata, worse functional status, elevated NT-proBNP levels (p=0.002), and shorter six-minute walk distances (p=0.007). Anaemia reduced the odds of clinical improvement by 75% (OR, 0.25; p=0.02). Over a follow-up of 57.8 months, 64 patients (50%) died. ACD (HR, 2.43; 95% CI, 1.03–5.7; p=0.04) and ACD/IDA (HR, 2.14; 95% CI, 1.04–4.41; p=0.04) independently predicted mortality, even after adjustment for age and risk. Conclusions: Anaemia, particularly ACD and ACD/IDA, independently predicts a lower probability of achieving therapeutic goals within 12 months and is associated with higher long-term mortality, even after adjustment for the ESC/ERS 2022 recommended risk stratification.
Keywords: pulmonary hypertension, Anaemia, prognosis, Idiopathic pulmonary hypertension, Risk stratication
Received: 19 Oct 2025; Accepted: 19 Nov 2025.
Copyright: © 2025 Waligóra, Mrowicka, Pietrus, Daniek, Kurczyna, Karnaś, Chaba, Jonas and Kopec. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Grzegorz Kopec, grzegorzkrakow1@gmail.com
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