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

Abstract Background: Heart failure (HF) is a syndrome, whose advanced forms have a poor prognosis, which is aggravated by the presence of comorbidities. Objective: We assessed the impact of infection in patients with decompensated HF admitted to a tertiary university-affiliated hospital in the city of São Paulo. Methods: This 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. Results: Of 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). Conclusions: Infection 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.

摘要 背景：心力衰竭（Heart Failure, HF）是一种综合征，其晚期预后较差，合并症会进一步加重病情。 目的：本研究评估了感染对圣保罗市某大学附属三级医院收治的失代偿性心力衰竭患者的影响。 方法：本研究连续纳入260例因失代偿性心力衰竭入住本科室的患者，收集患者感染及其他合并症情况、住院死亡率及出院后转归。通过单因素logistic回归分析各研究变量，评估患者的死亡风险，检验水准设定为P<0.05。 结果：纳入研究的患者中54.2%为男性，平均年龄±标准差（standard deviation, SD）为66.1±12.7岁。住院期间共有119例（45.8%）患者合并感染，其中88例（33.8%）诊断为肺部感染，39例（15.0%）诊断为尿路感染。住院期间共有56例（21.5%）患者死亡，出院后共有36例（17.6%）患者死亡。住院期间感染组患者死亡率为26.9%，未感染组为17.0%（P=0.05）；但出院后感染组死亡率显著低于未感染组，分别为11.5%与22.2%（P=0.046）。 结论：感染是失代偿性心力衰竭住院患者常见的合并症，合并感染的患者住院死亡率更高；但初始合并感染且存活的患者，出院后转归更佳。