Steven M. Kawut
· MD MSVerifiedUniversity of Pennsylvania · Rehabilitation Medicine
Active 1999–2025
About
Steven M. Kawut, MD, MS, is a Professor of Medicine in the Pulmonary, Allergy, and Critical Care Department at the Perelman School of Medicine, University of Pennsylvania. He is an attending physician at Pennsylvania Hospital, the Hospital of the University of Pennsylvania, and Penn Presbyterian Medical Center in Philadelphia. Dr. Kawut serves as the Director of the Pulmonary Vascular Disease Program and the Pulmonary Vascular Disease Research Program at the Penn Cardiovascular Institute. He is also a member of the Institute for Translational Medicine and Therapeutics and a Senior Scholar at the Center for Clinical Epidemiology and Biostatistics. His research focuses on the role of the pulmonary vasculature and right ventricular function in health and disease. He leads or contributes to epidemiologic studies and clinical trials related to pulmonary arterial hypertension, hepatopulmonary syndrome, and lung transplantation. His group also investigates congenital heart disease and pulmonary vascular disease in children. Dr. Kawut's educational background includes a biology degree from Harvard College, an MD from Yale School of Medicine, and a Master of Science in Clinical Epidemiology from the Perelman School of Medicine at the University of Pennsylvania.
Research topics
- Internal medicine
- Medicine
- Cardiology
- Physical therapy
- Psychiatry
- Intensive care medicine
Selected publications
CT Emphysema Subtypes and Cardiac Hemodynamics Estimated on MRI
CHEST Journal · 2025-03-28 · 2 citations
articleOpen accessAmbient Air Pollution Exposure and Mortality in the Pulmonary Hypertension Association Registry
Annals of the American Thoracic Society · 2025-06-16 · 1 citations
articleOpen accessAbstract Rationale The effects of long-term ambient air pollution exposure on survival in pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) remain unclear. Objectives To evaluate the association between exposure to particulate matter with aerodynamic diameter ≤ 2.5 μm (PM2.5), NO2, and O3 and mortality or lung transplant in the Pulmonary Hypertension Association Registry (PHAR). Methods A total of 2,196 adult patients enrolled in the PHAR provided data between 2015 and 2024. Annual average concentrations of air pollutants, including PM2.5, NO2, and O3, estimated from validated spatiotemporal models in 2015 were linked to each participant’s residential address. Cox proportional hazards models evaluated the associations between air pollutant exposures and risk of death or lung transplant, adjusting for baseline demographics, individual and neighborhood socioeconomic factors, disease severity, and spatial confounders. Additional analyses were adjusted for and stratified by nine U.S. census divisions. Results Study participants were broadly distributed across U.S. regions, with 72.0% female and a mean age of 55.7 years. A proportion of 35.6% had idiopathic PAH, 26.5% had connective tissue disease–associated PAH, and 14.5% had CTEPH. In models adjusted for demographics and individual and neighborhood socioeconomic factors, each interquartile range increase of PM2.5 was associated with a mortality or lung transplant hazard ratio of 1.16 (95% confidence interval, 1.01–1.33). This association was marginally attenuated and not statistically significant after adjusting for spatial covariates, with a hazard ratio of 1.12 (95% confidence interval, 0.95–1.31) per interquartile range increase in PM2.5. We noted regional variation in the observed associations. No significant associations were found with NO2 or O3. Conclusions Long-term ambient air pollution exposure was not significantly associated with survival in PHAR patients with PAH or CTEPH. Future research should investigate potential modifying effects of regional social determinants and healthcare-related factors on the relationship between air pollution exposure and mortality in these conditions.
UNC Libraries · 2025-04-18
articleOpen access<strong>Rationale:</strong> There is a noticeable underrepresentation of minorities in clinical trials and registries in pulmonary arterial hypertension (PAH). Prior studies evaluating the association between Hispanic ethnicity and clinical outcomes in patients with PAH have not assessed the socioeconomic profile of Hispanic individuals or the significance of social determinants of health in clinical outcomes. <strong>Objectives:</strong> To determine the association between Hispanic ethnicity, social determinants of health, and clinical outcomes in PAH. <strong>Methods:</strong> This was a prospective cohort study of adult participants with PAH enrolled in the Pulmonary Hypertension Association Registry, a multicenter U.S.-based registry of patients treated at pulmonary hypertension care centers. Participants were classified as Hispanics and non-Hispanic White individuals, based on self-reported ethnicity. A comparison of baseline clinical and sociodemographic characteristics between groups was performed as well using absolute standardized differences (ASD). The primary outcome of the study was to assess transplant-free survival between Hispanics and non-Hispanic White individuals. A Cox proportional hazards model was used for the multivariable analysis after adjusting for age, sex, PAH etiology, annual income, education level, and health insurance. <strong>Results:</strong> A total of 683 individuals were included, 98 (14.3%) of Hispanic ethnicity. Hispanic patients had impaired access to health care (31.6% vs. 12.9% Medicaid/uninsured; ASD, 0.35), lower education level (72.6% vs. 94.0% high school graduates or higher; ASD, 0.60), and lower annual income (32.0% vs. 17.4% with income <20,000 U.S. dollars; ASD, 0.47), compared with non-Hispanic White individuals. Hispanic patients had a higher frequency of emergency room visits and a higher number of hospitalizations, despite having similar disease severity (incidence rate ratio, 1.452; 95% confidence interval [CI], 1.326-1.590; and 1.428; 95% CI, 1.292-1.577, respectively). Although the unadjusted analysis showed a lower transplant/death hazard ratio for Hispanics (hazard ratio, 0.47; 95% CI, 0.24-0.94; <em>P</em> = 0.032), there was no association between Hispanic ethnicity and outcome in the multivariable model after adjusting for social determinants of health and other covariates (HR, 0.76; 95% CI, 0.35-1.62; <em>P</em> = 0.474). <strong>Conclusions:</strong> Hispanic ethnicity was not associated with differences in survival after adjusting for social determinants of health and other factors. Social determinants of health are important to consider when assessing the association between ethnicity and outcomes in PAH.
American Journal of Respiratory and Critical Care Medicine · 2025-05-01
articleAbstract Rationale: The misuse of prescription medications has contributed to increased mortality and morbidity in the US. Whether there is an association between the misuse of prescription drugs and pulmonary arterial hypertension (PAH) is unknown. We performed a multicenter study with the hypothesis that ever-misusing, age at first misuse, and duration of misuse of certain prescription medications is associated with the probability of PAH. Methods: XPOSE is an ongoing case-control study at ten academic pulmonary hypertension centers in the Western and mid-Western US. Cases were adults with idiopathic or methamphetamine-associated PAH recruited into the Pulmonary Hypertension Association Registry (PHAR). Controls were healthy adults without risk factors or diagnosis of PAH, seeking care at the institution. Participants completed a drug exposure questionnaire capturing self-reported use of substances (adapted from the 2020 National Survey on Drug Use and Health), including lifetime-ever misuse, age at first misuse, and duration of misuse of pain relievers, stimulants, tranquilizers, and sedatives. We used logistic regression to determine the relationship between case-control status and ever misuse as well as patterns of misuse of above prescription medications. Results: We included 496 participants (97 cases and 399 controls) enrolled between 2023-2024. Cases were younger with higher BMI, but were similar in sex at birth (Table 1). Cases and controls differed in terms of race, household income, insurance, education, employment, and marital status. There was no significant association between the misuse of prescription pain relievers (OR 0.99 (0.54, 1.83)), stimulants (OR 1.37 (0.67, 2.73)), tranquilizers (OR 1.15 (0.58, 2.23)), or sedatives (0.58 (0.21, 1.48)) and PAH case-status with or without adjustment for age, sex, BMI, income, and insurance status. Although we did not find an association between prescription stimulants and case-status, PAH patients appeared to report longer estimated duration of exposure compared to controls (24 [5, 175] vs 11 [2, 48] months, p=0.09) There were no differences in age at first misuse and duration of misuse between cases and controls. Conclusions: In this multicenter study, we found that misuse of prescription pain relievers, stimulants, tranquilizers and sedatives was not associated with case-control status. There were no differences in age of first misuse and duration of misuse between cases and controls. Larger studies are necessary to fully account for small sample size and potential confounders. More studies should be conducted to understand the differences between PAH and control populations and to explore the relationship between case-control status and prescription medication use.
Respiratory Medicine · 2025-01-22
articleOpen accessAntinuclear antibodies (ANA) are often found in ILD; whether ANA is associated with radiographic progression of quantitive interstitial lung changes is unknown. We performed longitudinal analyses of adults in the Multi-Ethnic Study of Atherosclerosis using linear mixed effects models with random intercept and slope to evaluate whether baseline ANA was associated with change in the amount of lung with high attenuation areas on CT (HAAs, percentage of imaged lung with -600 to -250 HU). In 6,638 subjects with 17,293 CT scans over 18 years, 741 (11 %) were ANA positive. ANA was not associated with HAA progression with ANA as a dichotomous variable (0.13 % less progression per year for ANA positive vs negative, 95%CI -0.33 %-0.07 %, p = 0.19) or as a continuous variable (0.004 % less progression per year per 10 % increase in ANA, 95%CI -0.01 %-0.005 %, p = 0.37). ANA was not associated with progression of HAA in community dwelling adults.
The Lancet Respiratory Medicine · 2025-02-20 · 11 citations
reviewOpen accessEuropean Respiratory Journal · 2025-07-10 · 2 citations
letterOpen access<title>Extract</title> Initial reports of pulmonary arterial hypertension(PAH) included young women with few comorbidities. Contemporary patients with PAH are frequently older, with greater burden of obesity and risk factors for heart failure with preserved ejection fraction(HFpEF). [1] Patients with clinical PAH and HFpEF risk factors often have dynamic left heart abnormalities unmasked with pulmonary vasodilation or exercise. [2] However, whether longitudinal functional benefit with pulmonary vasodilator therapy is different in those with risk factors remains uncertain, with conflicting results from existing studies [3–6].
Journal of the American Society of Nephrology · 2025-10-01
articleEuropean Respiratory Journal · 2025-05-22 · 4 citations
articleOpen accessBackground Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) cause right ventricular dysfunction with extrapulmonary sequelae including renal dysfunction. We sought to characterise renal dysfunction in PAH and CTEPH and to assess the effect of pulmonary hypertension treatment on renal function. Methods We performed an individual participant data meta-analysis of 6694 participants from 18 phase III randomised clinical trials of pulmonary hypertension therapies. We calculated estimated glomerular filtration rate (eGFR) using the race-agnostic 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Results The mean± sd age was 49.6±15.5 years, 78% were female and 58% had idiopathic PAH. A total of 907 (13.5%) participants had a baseline eGFR <60 mL·min −1 ·1.73 m −2 . Lower baseline eGFR correlated with higher mean right atrial pressure (mRAP) and lower cardiac index. At 12–16 weeks, a 10 mmHg decrease in mRAP from baseline or a 1 L·min −1 ·m −2 increase in cardiac index was associated with only a 1.7 mL·min −1 ·1.73 m −2 (95% CI −2.9–−0.5 mL·min −1 ·1.73 m −2 ; p=0.006) or a 1.4 mL·min −1 ·1.73 m −2 (95% CI 0.5–2.4 mL·min −1 ·1.73 m −2 ; p=0.003) increase in eGFR, respectively. A 10 mL·min −1 ·1.73 m −2 lower baseline eGFR was associated with an increased risk of all-cause mortality (adjusted hazard ratio 1.16, 95% CI 1.08–1.23; p<0.001). Interestingly, pulmonary hypertension treatment was associated with only a small improvement in eGFR at 12–16 weeks (adjusted β 2.0 mL·min −1 ·1.73 m −2 , 95% CI 1.4–2.6 mL·min −1 ·1.73 m −2 ; p<0.001). Conclusion Renal dysfunction remains highly prevalent in PAH and CTEPH and is associated with worse haemodynamics and worse clinical outcomes. In this cohort with relatively preserved renal function, pulmonary hypertension treatment was associated with only a minimal improvement in eGFR.
How Patients With Amyotrophic Lateral Sclerosis Perceive Respiratory Interventions
Neurology Clinical Practice · 2025-11-10
articleOpen accessBackground and Objectives: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that commonly leads to respiratory failure. Early respiratory interventions that may improve symptoms and outcomes are underused when prescribed. We sought to characterize patient perspectives and preferences for respiratory care to enable identification of implementation strategies to improve the uptake of ALS respiratory interventions. Methods: A prospective multicenter mixed-methods observational study was conducted using semistructured interviews of participants recently diagnosed with ALS at 4 academic centers in the United States. Eligible patients were those with an ALS diagnosis in the previous 12 months, forced vital capacity <80% predicted normal, or presence of dyspnea or orthopnea. Results: Twenty-four patients with ALS were interviewed. Ten participants were using some form of respiratory therapy, including 8 using noninvasive ventilation (NIV). The most endorsed factors related to openness to initiate respiratory therapy were a doctor's recommendation and abnormal pulmonary function test results. The most commonly endorsed preferences for learning about a respiratory device included kinesthetic and reading. Descriptions of lung volume recruitment were received with more openness than of NIV. For those not prescribed NIV, reasons for hesitancy to start NIV included fear of mask discomfort, claustrophobia, and lack of perceived benefit. Perceptions about NIV differed in participants identifying as "proactive" rather than "reactive" with their health. Discussion: Patients in the first year after ALS diagnosis have variable receptiveness to respiratory care. These patients place different weights on the factors supporting NIV and may have different educational needs about respiratory interventions. Implementation strategies for respiratory care interventions in ALS should consider patients' motivations for adopting interventions such as NIV, provide multiple educational formats, and identify barriers to incorporating home respiratory care.
Recent grants
NIH · $2.0M · 2012
NIH · $5.1M · 2018
NIH · $2.4M · 2011
NIH · $3.8M · 2018
NIH · $641k · 2007
Frequent coauthors
- 359 shared
João A.C. Lima
Johns Hopkins Medicine
- 286 shared
David A. Bluemke
University of Wisconsin–Madison
- 263 shared
R. Graham Barr
Columbia University Irving Medical Center
- 254 shared
David J. Lederer
Regeneron (United States)
- 188 shared
Eric A. Hoffman
University of Iowa
- 162 shared
R. Graham Barr
Columbia University Irving Medical Center
- 151 shared
Harjit Chahal
MedStar Heart & Vascular Institute
- 146 shared
Harikrishna Tandri
Vanderbilt University Medical Center
Labs
Pulmonary Vascular Disease Research ProgramPI
Education
AB
Harvard University
MS, Epidemology
Perelman School of Medicine, University of Pennsylvania
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