Association of chronic heart failure with mortality in old intensive care patients suffering from Covid‐19

Abstract

Aims Chronic heart failure (CHF) is a major risk factor for mortality in coronavirus disease 2019 (COVID‐19). This prospective international multicentre study investigates the role of pre‐existing CHF on clinical outcomes of critically ill old (≥70 years) intensive care patients with COVID‐19. Methods and results Patients with pre‐existing CHF were subclassified as having ischaemic or non‐ischaemic cardiac disease; patients with a documented ejection fraction (EF) were subclassified according to heart failure EF: reduced (HFrEF, n = 132), mild (HFmrEF, n = 91), or preserved (HFpEF, n = 103). Associations of heart failure characteristics with the 30 day mortality were analysed in univariate and multivariate logistic regression analyses. Pre‐existing CHF was reported in 566 of 3917 patients (14%). Patients with CHF were older, frailer, and had significantly higher SOFA scores on admission. CHF patients showed significantly higher crude 30 day mortality [60% vs. 48%, P < 0.001; odds ratio 1.87, 95% confidence interval (CI) 1.5–2.3] and 3 month mortality (69% vs. 56%, P < 0.001). After multivariate adjustment for confounders (SOFA, age, sex, and frailty), no independent association of CHF with mortality remained [adjusted odds ratio (aOR) 1.2, 95% CI 0.5–1.5; P = 0.137]. More patients suffered from pre‐existing ischaemic than from non‐ischaemic disease [233 vs. 328 patients (n = 5 unknown aetiology)]. There were no differences in baseline characteristics between ischaemic and non‐ischaemic disease or between HFrEF, HFmrEF, and HFpEF. Crude 30 day mortality was significantly higher in HFrEF compared with HFpEF (64% vs. 48%, P = 0.042). EF as a continuous variable was not independently associated with 30 day mortality (aOR 0.98, 95% CI 0.9–1.0; P = 0.128). Conclusions In critically ill older COVID‐19 patients, pre‐existing CHF was not independently associated with 30 day mortality. Trial registration number: NCT04321265.

Acute Kidney Injury and Chronic Kidney Disease and Their Impacts on Prognosis among Patients with Severe COVID-19 Pneumonia: An Expert Center Case–Cohort Study

“…Lower platelet counts in the CKD group compared to the NKF group (247.3 ± 102.5 vs. 299.3 ± 115.7 [1 × 10 3 /mm 3 ], p = 0.036) may result from inflammation and subsequent disseminated coagulation. Higher concentrations of lactates in patients with CKD compared to the group with preserved renal function correspond with a higher mortality rate, which is reported in another study concerning risk factors in COVID-19 patients [36]. In the performed univariable logistic regression, CKD was also significantly associated with mortality (OR 4.044, 95%CI: 1.723-9.490, p = 0.013).…”

Clinical Characteristics and Prognosis of Older Patients with Coronavirus Disease 2019 Requiring Mechanical Ventilation

“…In support of this approach, previous research has indicated that considerations regarding life-sustaining treatment significantly influence prognosis [20]. In addition, although not evaluated in this study, an older age is considered a significant risk factor for severe outcomes from COVID-19 [29,30], with chronic disease [4,31], a higher degree of frailty [12], a higher SOFA score [6,32], and elevated levels of inflammatory markers [33,34] generally being associated with worse clinical outcomes. These complexities call for a comprehensive management strategy that addresses both the direct effects of COVID-19 and the broader underlying health issues that affect older patients, especially those requiring intensive interventions such as CRRT.…”

Charlson comorbidity index and the severity of community-acquired pneumonia caused by SARS-CoV-2: A retrospective analysis

“…40 However, a study conducted by Bruno et al examined the impact of the pre-existing chronic heart failure on the clinical outcomes of critically ill elderly patients (≥70 years) receiving intensive care for COVID-19, and concluded that the pre-existing condition did not influence 30-day mortality. 41 Due to immune dysregulation, chronic liver diseases are believed to put affected individuals at risk of adverse outcomes following infection with SARS-CoV-2. Recent reports have indicated that patients with the pre-existing chronic liver diseases have a high mortality rate for COVID-19, with an associated mortality rate of 39.8%.…”