Introduction: COVID-19 often triggers acute pulmonary hypertension, a life-threatening vascular complication whose risk is markedly amplified by obesity in critically ill patients. However, the precise incidence of this hemodynamic condition within intensive care settings remains inadequately quantified. Therefore, this study aimed to determine the incidence of pulmonary hypertension in obese COVID-19 patients admitted to intensive care units.

Material and methods: This descriptive cross-sectional study was conducted at Imam Reza Hospital. Using convenience sampling and the Cochran formula, a sample of 71 obese COVID-19 patients was recruited. The procedure involved comprehensive assessment of hemodynamic parameters, including pulmonary artery pressures, oxygen saturation, and anthropometric data, to evaluate the incidence of pulmonary hypertension in the intensive care setting.

Results: In critically ill COVID-19 patients, pulmonary hypertension (PH) was associated with higher BMI (36.5±3.4 vs. 32.8±2.9 kg/m²; p=0.002), elevated APACHE II scores (18.6±4.1 vs. 14.8±3.5; p=0.001), longer ICU stay (14.1±5.6 vs. 11.2±4.2 days; p=0.015), and severe impairment in PASP (48.6±7.5 mmHg; p<0.001), mPAP (32.4±5.6 mmHg; p<0.001), PaO2/FiO2 (165.2±38.6; p=0.004), D-dimer (2800 ng/mL; p=0.001), and CRP (72.8±18.5 mg/L; p=0.003). Class III obesity independently portended the greatest risk (OR=7.95; p<0.001).

Conclusion: Severe obesity independently drives acute pulmonary vascular complications in critically ill COVID-19 patients, significantly worsening hemodynamics, oxygenation, systemic inflammation, and clinical outcomes. Escalating adiposity classes exhibit a clear dose-dependent risk of pulmonary hypertension. Early hemodynamic evaluation and targeted vascular therapies are imperative in obese ICU patients with COVID-19 to mitigate microvascular injury and improve survival.