Pneumonia and inflammation in acute decompensated heart failure: a registry-based analysis of 1939 patients

Jobs, Alexander; Simon, Ronja; Waha, Suzanne de; Rogačev, Kyrill S.; Katalinic, Alexander; Babaev, Valentin; Thiele, Holger

doi:10.1177/2048872617700874

Cited by 27 publications

(28 citation statements)

References 31 publications

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“…This association of CSI with hemodynamic data emphasizes the mechanistic plausibility of our results. Recent registry data have shown that approximately 20% of patients hospitalized for AHF had concomitant lung diseases such as pneumonia and COPD [35][36][37], and these patients generally excluded in previous reports assessing the diagnostic value of CXR [16,17,38,39]. However, our subgroup analysis provided a remarkably homogenous diagnostic performance of CSI across various subgroups (i.e., elderly and BMI) and coexisting lung diseases (i.e., COPD and pneumonia).…”

Section: Discussionmentioning

confidence: 74%

Diagnostic performance of congestion score index evaluated from chest radiography for acute heart failure in the emergency department: A retrospective analysis from the PARADISE cohort

et al. 2020

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Background Congestion score index (CSI), a semiquantitative evaluation of congestion on chest radiography (CXR), is associated with outcome in patients with heart failure (HF). However, its diagnostic value in patients admitted for acute dyspnea has yet to be evaluated. Methods and findings The diagnostic value of CSI for acute HF (AHF; adjudicated from patients’ discharge files) was studied in the Pathway of dyspneic patients in Emergency (PARADISE) cohort, including patients aged 18 years or older admitted for acute dyspnea in the emergency department (ED) of the Nancy University Hospital (France) between January 1, 2015 and December 31, 2015. CSI (ranging from 0 to 3) was evaluated using a semiquantitative method on CXR in consecutive patients admitted for acute dyspnea in the ED. Results were validated in independent cohorts (N = 224). Of 1,333 patients, mean (standard deviation [SD]) age was 72.0 (18.5) years, 686 (51.5%) were men, and mean (SD) CSI was 1.42 (0.79). Patients with higher CSI had more cardiovascular comorbidities, more severe congestion, higher b-type natriuretic peptide (BNP), poorer renal function, and more respiratory acidosis. AHF was diagnosed in 289 (21.7%) patients. CSI was significantly associated with AHF diagnosis (adjusted odds ratio [OR] for 0.1 unit CSI increase 1.19, 95% CI 1.16–1.22, p < 0.001) after adjustment for clinical-based diagnostic score including age, comorbidity burden, dyspnea, and clinical congestion. The diagnostic accuracy of CSI for AHF was >0.80, whether alone (area under the receiver operating characteristic curve [AUROC] 0.84, 95% CI 0.82–0.86) or in addition to the clinical model (AUROC 0.87, 95% CI 0.85–0.90). CSI improved diagnostic accuracy on top of clinical variables (net reclassification improvement [NRI] = 94.9%) and clinical variables plus BNP (NRI = 55.0%). Similar diagnostic accuracy was observed in the validation cohorts (AUROC 0.75, 95% CI 0.68–0.82). The key limitation of our derivation cohort was its single-center and retrospective nature, which was counterbalanced by the validation in the independent cohorts. Conclusions In this study, we observed that a systematic semiquantified assessment of radiographic pulmonary congestion showed high diagnostic value for AHF in dyspneic patients. Better use of CXR may provide an inexpensive, widely, and readily available method for AHF triage in the ED.

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Section: Discussionmentioning

confidence: 74%

Diagnostic performance of congestion score index evaluated from chest radiography for acute heart failure in the emergency department: A retrospective analysis from the PARADISE cohort

et al. 2020

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“…14 Further evidence for a role of inflammation in the pathogenesis of acute heart failure comes from a large registry that assessed the prognostic impact of pneumonia and signs of systemic inflammation in patients with acute heart failure. 15 In this registry pneumonia was relatively common but inflammation in general seemed more important than pneumonia itself for long-term prognosis as only C-reactive protein was an independent predictor for long-term mortality.…”

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confidence: 89%

Focus on acute heart failure: prehospital diagnosis, ultrasound examination and monitoring, pathophysiology, diuretic resistance

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2018

European Heart Journal: Acute Cardiovascular Care

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“…8 Inflammation diagnosed by C-reactive protein during pneumonia was independently associated with in-hospital and long-term mortality. 6 Experimental data indicated that pulmonary congestion may facilitate the growth of bacteria commonly seen in pneumonia. 6 Also, pulmonary congestion was identified as an independent predictor of pneumonia.…”

Section: Laboratory Datamentioning

confidence: 99%

Worsening of heart failure by coronavirus disease 2019 is associated with high mortality

et al. 2021

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Aims Patients with advanced heart failure (HF) with reduced left ventricular ejection fraction (HFrEF) and concurrent coronavirus disease 2019 (COVID-19) might have a higher risk of severe events. Methods and results We retrospectively studied 16 patients with advanced HFrEF who developed COVID-19 between 1 March and 29 May 2020. Follow-up lasted until 30 September. Ten patients previously hospitalized with decompensated HFrEF were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during hospitalization. Six patients undergoing ambulatory care at initiation of COVID-19 symptoms were hospitalized because of advanced HFrEF. All patients who experienced worsening of HFrEF due to COVID-19 required higher doses or introduction of additional inotropic drugs or intra-aortic balloon pump in the intensive care unit. The mean intravenous dobutamine dose before SARS-CoV-2 infection in previously hospitalized patients (n = 10) and the median (inter-quartile range) peak intravenous dobutamine dose during SARS-CoV-2 infection in all patients (n = 16) were 2 (0-7) μg/kg/min and 20 (14-20) (P < 0.001), respectively. During follow-up, 56% underwent heart transplantation (n = 2) or died (n = 7). Four patients died during hospitalization from mixed shock consequent to severe acute respiratory syndrome with inflammatory storm syndrome associated with septic and cardiogenic shock during COVID-19. After COVID-19 recovery, two patients died from mixed septic and cardiogenic shock and one from sustained ventricular tachycardia and cardiogenic shock. Five patients were discharged from hospital to ambulatory care. Four were awaiting heart transplantation. Conclusion Worsening of advanced HF by COVID-19 is associated with high mortality. This report highlights the importance of preventing COVID-19 in patients with advanced HF.

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Pneumonia and inflammation in acute decompensated heart failure: a registry-based analysis of 1939 patients

Cited by 27 publications

References 31 publications

Diagnostic performance of congestion score index evaluated from chest radiography for acute heart failure in the emergency department: A retrospective analysis from the PARADISE cohort

Diagnostic performance of congestion score index evaluated from chest radiography for acute heart failure in the emergency department: A retrospective analysis from the PARADISE cohort

Focus on acute heart failure: prehospital diagnosis, ultrasound examination and monitoring, pathophysiology, diuretic resistance

Worsening of heart failure by coronavirus disease 2019 is associated with high mortality

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