Predictors and prognostic implications of hospital-acquired pneumonia in patients admitted for acute heart failure

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

Mihajlo Viduljević¹  Andrea Stojićević¹  Nataša Zlatić¹  Danka Civrić¹  Milenko Tomić¹  Aleksandra Milošević²  Ratko Lasica²  Milika Ašanin²  Marija Polovina²  Gordana Krljanac² 

[1] Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia;Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia;Faculty of Medicine, University of Belgrade, Belgrade, Serbia;

关键词: acute heart failure;    hospital acquired pneumonia;    intensive care unit;    mortality;    heart failure treatment;   

DOI  :  10.3389/fcvm.2023.1254306

 received in 2023-07-06, accepted in 2023-09-05,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionData on predictors and prognosis of hospital acquired pneumonia (HAP) in patients admitted for acute heart failure (AHF) to intensive care units (ICU) are scarce. Better knowledge of these factors may inform management strategies. This study aimed to assess the incidence and predictors of HAP and its impact on management and outcomes in patients hospitalised for AHF in the ICU.Methodsthis was a retrospective single-centre observational study. Patient-level and outcome data were collected from an anonymized registry-based dataset. Primary outcome was in-hospital all-cause mortality and secondary outcomes included length of stay (LOS), requirement for inotropic/ventilatory support, and prescription patterns of heart failure (HF) drug classes at discharge.ResultsOf 638 patients with AHF (mean age, 71.6 ± 12.7 years, 61.9% male), HAP occurred in 137 (21.5%). In multivariable analysis, HAP was predicted by de novo AHF, higher NT proB-type natriuretic peptide levels, pleural effusion on chest x-ray, mitral regurgitation, and a history of stroke, diabetes, and chronic kidney disease. Patients with HAP had a longer LOS, and a greater likelihood of requiring inotropes (adjusted odds ratio, OR, 2.31, 95% confidence interval, CI, 2.16–2.81; p < 0.001) or ventilatory support (adjusted OR 2.11, 95%CI, 1.76–2.79, p < 0.001). After adjusting for age, sex and clinical covariates, all-cause in-hospital mortality was significantly higher in patients with HAP (hazard ratio, 2.10; 95%CI, 1.71–2.84; p < 0.001). Patients recovering from HAP were less likely to receive HF medications at discharge.DiscussionHAP is frequent in AHF patients in the ICU setting and more prevalent in individuals with de novo AHF, mitral regurgitation, higher burden of comorbidities, and more severe congestion. HAP confers a greater risk of complications and in-hospital mortality, and a lower likelihood of receiving evidence-based HF medications at discharge.

【 授权许可】

Unknown   
© 2023 Polovina, Tomić, Viduljević, Zlatić, Stojićević, Civrić, Milošević, Krljanac, Lasica and Ašanin.