ObjectivesPatients with congestive heart failure (CHF) may be at a higher risk of mortality from sepsis than patients without CHF due to insufficient cardiovascular reserves during systemic infections. The aim of this study is to compare sepsis-related mortality between CHF and no CHF in patients presenting to a tertiary medical centre.DesignA single-centre, retrospective, cohort study.SettingConducted in an academic emergency department (ED) between January 2010 and January 2015. Patients’ charts were queried via the hospital’s electronic system. Patients with a diagnosis of sepsis were included. Descriptive analysis was performed on the demographics, characteristics and outcomes of patients with sepsis of the study population.ParticipantsA total of 174 patients, of which 87 (50%) were patients with CHF.Primary and secondary outcomesThe primary outcome of the study was in-hospital mortality. Secondary outcomes included intensive care unit (ICU) and hospital lengths of stay, and differences in interventions between the two groups.ResultsPatients with CHF had a higher in-hospital mortality (57.5% vs 34.5%). Patients with sepsis and CHF had higher odds of death compared with the control population (OR 2.45; 95% CI 1.22 to 4.88). Secondary analyses showed that patients with CHF had lower instances of bacteraemia on presentation to the ED (31.8% vs 46.4%). They had less intravenous fluid requirements in first 24 hours (2.75±2.28 L vs 3.67±2.82 L, p =0.038), had a higher rate of intubation in the ED (24.2% vs 10.6%, p=0.025) and required more dobutamine in the first 24 hours (16.1% vs 1.1%, p<0.001). ED length of stay was found to be lower in patients with CHF (15.12±24.45 hours vs 18.17±26.13 hours, p=0.418) and they were more likely to be admitted to the ICU (59.8% vs 48.8%, p=0.149).ConclusionPatients with sepsis and CHF experienced an increased hospital mortality compared with patients without CHF.

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Background Kidney dysfunction (KD) is largely associated to cardiovascular mortality. Purpose Analyse early management and outcome in real life of ST segment elevation myocardial infarction (STEMI) patients with KD compared to STEMI patients with normal renal function. Methods Using 10 years' data from OSCAR regional registry, we investigated the early management and outcome of all patients with STEMI. Kidney dysfunction (KD) has been defined by creatinine clearance (CrCl) <90mL/min and was assessed using Cockcroft-Gault (CG) equation. Among them, two groups were identified: patients with normal kidney function (NKF) (CrCl ≥90mL/min) and patients with KD (CrCl <90mL/min). KD patients were stratified into 3 groups: patients with mild KD (CrCl 60–90mL/min), patients with moderate KD (CrCl 30–60mL/min) and patients with severe KD (CrCl <30mL/min). The comparison of the groups concerned patient characteristics, therapeutic strategy and follow-up at 1, 6 and 12 months. Results Our study included 8 003 STEMI patients from 2009 to 2018, 4 234 (52.9%) of them with KD. Among these, 2441 (57.6%) patients had mild KD, 1494 (35.3%) moderate KD and 299 (7.1%) severe KD. NKF patients were younger than KD group (54 [48–61] vs 72 [63–81]). KD patients had more cardiovascular risk factors such as diabetes, hypertension and personal history of coronary disease (p<0.001), but were less smokers (p<0,001). KD patients presented less often chest pain, and more dyspnea or cardiac arrest (p<0,001). There was no difference in symptom-first medical contact delay (p=0.30). More than 14% of patients with KD presented with Killip≥2. In the KD group location of infarction was more often anterior and lateral. In-hospital treatment differed among the groups: KD patients received less prasugrel (11% vs 20%), ticagrelor (44% vs 49%), enoxaparin (70% vs 80%), morphine (29% vs 39%) or other analgesic (30% vs 35%), but more clopidogrel (33% vs 23%), diuretics (3% vs 0,7%) and catecholamines (5% vs 2%) (p<0.001). In-hospital mortality was higher in the KD group (9% vs 1%, p<0.001). One-year mortality was 14% in the KD group compared to 2% for patients with NKF (p<0.001). Also, in-hospital mortality was increasing exponentially with KD severity (2%, 8% and 24% for mild, moderate and severe KD) (p<0,001) as well as 1-year mortality (respectively 1%, 6% and 12% after 1 year) (p<0,001). Conclusion Kidney insufficiency is an independent risk factor for death in patients after myocardial infarction and was associated with poor prognosis at short- and long-term. We observed that mortality increased with KD severity. Despite a high cardiovascular risk, KD patients presenting STEMI are less likely to receive therapy, while having more co-morbidities and extended infarction. To achieve an optimal medical care of KD patients with STEMI, we should introduce evidence-based therapies in the acute phase.

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