Internal Medicine B, Beilinson campus, Rabin Medical Center, Petach Tikva and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
PLoS One. 2013 Aug 23;8(8):e72476. doi: 10.1371/journal.pone.0072476. eCollection 2013.
Infections are one of the most common causes for hospitalization of patients with heart failure (HF). Yet, little is known regarding the prevalence and predictors of different types of acute infections as well as their impact on outcome among this growing population.
We identified all patients aged 50 or older with a major diagnosis of HF and at least one echocardiography examination who had been hospitalized over a 10-year period (January 2000 and December 2009). Infection-associated admissions were identified according to discharge diagnoses. Among 9,335 HF patients, 3530 (38%) were hospitalized at least once due to infections. The most frequent diagnoses were respiratory infection (52.6%) and sepsis/bacteremia (23.6%) followed by urinary (15.7%) and skin and soft tissue infections (7.8%). Hospitalizations due to infections compared to other indications were associated with increased 30-day mortality (13% vs. 8%, p<0.0001). These higher mortality rates were predominately related to respiratory infections (OR 1.28 [95% CI 1.09, 1.5]) and sepsis\bacteremia (OR 3.13 [95% CI 2.6, 3.7]). Important predictors for these serious infections included female gender, chronic obstructive pulmonary disease, past myocardial infarction and echocardiography-defined significant right (RV) but not left ventricular dysfunction.
Major infection-related hospitalizations are frequent among patients with HF and are associated with increased mortality rates. Elderly female patients with multiple comorbidities and those with severe RV dysfunction are at higher risk for these infections.
感染是心力衰竭（HF）患者住院的最常见原因之一。然而，对于不同类型的急性感染的流行情况及其在这一不断增长的人群中的预后影响，我们知之甚少。
我们确定了所有年龄在 50 岁或以上、有主要 HF 诊断且至少进行过一次超声心动图检查的患者，这些患者在 10 年期间（2000 年 1 月至 2009 年 12 月）住院。根据出院诊断确定与感染相关的入院。在 9335 例 HF 患者中，有 3530 例（38%）至少因感染住院一次。最常见的诊断是呼吸道感染（52.6%）和败血症/菌血症（23.6%），其次是尿路感染（15.7%）和皮肤和软组织感染（7.8%）。与其他原因相比，因感染而住院与 30 天死亡率增加相关（13%比 8%，p<0.0001）。这些更高的死亡率主要与呼吸道感染（OR 1.28[95%CI 1.09,1.5]）和败血症/菌血症（OR 3.13[95%CI 2.6,3.7]）有关。这些严重感染的重要预测因素包括女性性别、慢性阻塞性肺疾病、既往心肌梗死和超声心动图定义的右心室（RV）但不是左心室功能障碍。
HF 患者中与感染相关的主要住院治疗很常见，且与死亡率增加相关。患有多种合并症且 RV 功能严重受损的老年女性患者发生这些感染的风险更高。
