Impact of congestive heart failure on severe sepsis and septic shock survivors: outcomes and performance status after 1-year hospital discharge

Alkhalaf, Moussa; Abd-Aziz, Noorizan; Arabi, Yaseen M.; Tangiisuran, Balamurugan

doi:10.1186/cc11007

Cited by 3 publications

(4 citation statements)

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“…The core management of sepsis seems to be a paradox in patients with HF as the fluid bolus and vasoactive agents required in sepsis raise concerns in the context of cardiac dysfunction in such cases ( 21 ). These patients have worse clinical outcomes ( 22 ), even after hospital discharge ( 23 ). However, there is limited evidence on the influence of fluid resuscitation on the outcomes of patients with sepsis with pre-existing HF ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Association of Fluid Management With Mortality of Sepsis Patients With Congestive Heart Failure: A Retrospective Cohort Study

Dong

Gao

et al. 2022

Front. Med.

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Sepsis management includes intravenous fluid (IVF) resuscitation, but patients with pre-existing congestive heart failure (CHF) have a higher risk of fluid overload. Further, patients with sepsis with concomitant CHF present worse clinical outcomes. Nevertheless, there is limited evidence of the association between fluid management and the outcomes of patients with concomitant sepsis and CHF. This retrospective cohort study aimed to evaluate the association between fluid management and in-hospital mortality in patients with sepsis and concomitant heart failure (HF). The patients' data were extracted from the Multi-parameter Intelligent Monitoring in Intensive Care III Database. The primary outcome was in-hospital mortality. A restricted cubic spline model was used to explore the relationship between variables and in-hospital mortality. Logistic models were built using the linear spline function and design variables to investigate the association of fluid balance (FB), fluid intake (FI), and fluid accumulation index (FAI, calculated as the FB/FI ratio) with mortality. Overall, 1,801 patients were included. The overall mortality rate was 27.7%. After adjusting for confounding variables, FAI was found to be associated with in-hospital mortality, whereas FB and FI were not. With FAI values of 0–0.42 set as references, FAI values <0 were not associated with in-hospital mortality [odds ratio (OR): 1.078; 95% confidence interval (CI): 0.774–1.503], whereas FAI values > 0.42 were significantly associated with higher in-hospital mortality (OR: 1.461; 95% CI: 1.099–1.954). High FAI values (>0.42) were associated with high in-hospital mortality in patients with sepsis with HF, while FB and FI were not. Proper fluid management may improve the outcomes of patients with sepsis and concomitant HF.

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Section: Discussionmentioning

confidence: 99%

Association of Fluid Management With Mortality of Sepsis Patients With Congestive Heart Failure: A Retrospective Cohort Study

Dong

Gao

et al. 2022

Front. Med.

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“…One study looked at severe sepsis and septic shock survivors after hospital discharge; they examined a subgroup of patients with HF and showed that they had increased 3-month and 1-year mortalities as compared with the general population. 4 Another study looked at pneumonia patients and studied the prognostic role of HF on mortality. The authors were able to show that the 30-day mortality was 24.4% among patients with heart failure and 14.4% among those without HF.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of patients with systolic heart failure presenting with sepsis to the emergency department of a tertiary hospital: a retrospective chart review study from Lebanon

et al. 2018

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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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“…Long-term outcomes of sepsis may also worsen in HF patients. Patients with severe sepsis/septic shock and comorbid HF had a 75% mortality rate 1 year postdischarge, 15 which is larger than the severe sepsis 1-year mortality rate (40%-44%) 16,17 and 10-year mortality rates for severe sepsis (67%) and nonseptic critical illness (57%). 18…”

Section: Methodsmentioning

confidence: 87%

“…150 Despite the absence of clear outcomes data, patients with sepsis with preexisting HF have more dobutamine use than those with sepsis and no HF. 11,15 Whether dobutamine has a specific impact on outcomes for patients with preexisting HF remains unknown.…”

Section: Methodsmentioning

confidence: 99%

Sepsis With Preexisting Heart Failure: Management of Confounding Clinical Features

Jones

Smith

Tuyl

et al. 2020

J Intensive Care Med

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Preexisting heart failure (HF) in patients with sepsis is associated with worse clinical outcomes. Core sepsis management includes aggressive volume resuscitation followed by vasopressors (and potentially inotropes) if fluid is inadequate to restore perfusion; however, large fluid boluses and vasoactive agents are concerning amid the cardiac dysfunction of HF. This review summarizes evidence regarding the influence of HF on sepsis clinical outcomes, pathophysiologic concerns, resuscitation targets, hemodynamic interventions, and adjunct management (ie, antiarrhythmics, positive pressure ventilatory support, and renal replacement therapy) in patients with sepsis and preexisting HF. Patients with sepsis and preexisting HF receive less fluid during resuscitation; however, evidence suggests traditional fluid resuscitation targets do not increase the risk of adverse events in HF patients with sepsis and likely improve outcomes. Norepinephrine remains the most well-supported vasopressor for patients with sepsis with preexisting HF, while dopamine may induce more cardiac adverse events. Dobutamine should be used cautiously given its generally detrimental effects but may have an application when combined with norepinephrine in patients with low cardiac output. Management of chronic HF medications warrants careful consideration for continuation or discontinuation upon development of sepsis, and β-blockers may be appropriate to continue in the absence of acute hemodynamic decompensation. Optimal management of atrial fibrillation may include β-blockers after acute hemodynamic stabilization as they have also shown independent benefits in sepsis. Positive pressure ventilatory support and renal replacement must be carefully monitored for effects on cardiac function when HF is present.

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Impact of congestive heart failure on severe sepsis and septic shock survivors: outcomes and performance status after 1-year hospital discharge

Cited by 3 publications

References 0 publications

Association of Fluid Management With Mortality of Sepsis Patients With Congestive Heart Failure: A Retrospective Cohort Study

Association of Fluid Management With Mortality of Sepsis Patients With Congestive Heart Failure: A Retrospective Cohort Study

Outcomes of patients with systolic heart failure presenting with sepsis to the emergency department of a tertiary hospital: a retrospective chart review study from Lebanon

Sepsis With Preexisting Heart Failure: Management of Confounding Clinical Features

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