Infection in Patients with Decompensated Heart Failure: In-Hospital Mortality and Outcome

Abstract

BackgroundHeart failure (HF) is a syndrome, whose advanced forms have a poor prognosis, which is aggravated by the presence of comorbidities.ObjectiveWe assessed the impact of infection in patients with decompensated HF admitted to a tertiary university-affiliated hospital in the city of São Paulo.MethodsThis study assessed 260 patients consecutively admitted to our unit because of decompensated HF. The presence of infection and other morbidities was assessed, as were in-hospital mortality and outcome after discharge. The chance of death was estimated by univariate logistic regression analysis of the variables studied. The significance level adopted was P < 0.05.ResultsOf the patients studied, 54.2% were of the male sex, and the mean age ± SD was 66.1 ± 12.7 years. During hospitalization, 119 patients (45.8%) had infection: 88 (33.8%) being diagnosed with pulmonary infection and 39 patients (15.0%), with urinary infection. During hospitalization, 56 patients (21.5%) died, and, after discharge, 36 patients (17.6%). During hospitalization, 26.9% of the patients with infection died vs 17% of those without infection (p = 0.05). However, after discharge, mortality was lower in the group that had infection: 11.5% vs 22.2% (p = 0.046).ConclusionsInfection is a frequent morbidity among patients with HF admitted for compensation of the condition, and those with infection show higher in-hospital mortality. However, those patients who initially had infection and survived had a better outcome after discharge.

Risk factors for 28-day mortality in patients with sepsis-related myocardial injury in intensive care units

“… 16 Cardoso et al. 17 reported that the mortality rate in patients with infection and cardiac insufficiency was higher than that in patients with infection alone (21.5% vs 17.6%, P < 0.05). Therefore, patients with sepsis and pulmonary infection may also have pulmonary hypertension, which increases the cardiac load and aggravates myocardial injury, thus leading to a higher risk of death.…”

Medication as a risk factor for hospitalization due to heart failure and shock: a series of case-crossover studies in Swiss claims data

“…Prescriptions of amoxicillin and clavulanic acid can serve as proxy for the underlying infection. Infections were reported to be common precipitating factors for HF decompensation requiring hospital admission, especially with respiratory infection being common [12,13,15,16]. Accordingly, our study found a significantly increased risk for hospitalization after amoxicillin/ clavulanic acid prescription (OR 3.25, 15 days).…”

“…While medications themselves may be risk factors for decompensation or development of HF, they can also serve as proxies for acute conditions presenting potential risk factors. Conditions such as arrhythmia, worsening renal function, and infections [12,13] are common complications in patients suffering from HF and were described to be precipitating factors for HF hospitalization [3,[14][15][16][17][18]. Additionally, electrolyte imbalances appear frequently in HF patients [19][20][21][22], especially as several drugs commonly used in heart failure treatment may lead to hypo-or hyperkalemia, respectively [23,24].…”

Factors that influence the length of hospitalization for acute heart failure patients in RSUP Dr. M Djamil

“…As it is known, pulmonary infection is one of the risk factors for higher mortality rates in acute HF patients in the treatment. 11 But this patient's data does not include patients who died because we did not measure the mortality rate in this study.…”