Department of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto Japan.
Clinical Epidemiology Hyogo College of Medicine Nishinomiya Japan.
J Am Heart Assoc. 2021 Nov 16;10(22):e023256. doi: 10.1161/JAHA.121.023256. Epub 2021 Nov 3.
Background No studies have explored the association between newly diagnosed infections after admission and clinical outcomes in patients with acute heart failure. We aimed to explore the factors associated with newly diagnosed infection after admission for acute heart failure, and its association with in-hospital and post-discharge clinical outcomes. Methods and Results Among 4056 patients enrolled in the Kyoto Congestive Heart Failure registry, 2399 patients without any obvious infectious disease upon admission were analyzed. The major in-hospital and post-discharge outcome measures were all-cause deaths. There were 215 patients (9.0%) with newly diagnosed infections during hospitalization, and 2184 patients (91.0%) without infection during hospitalization. The factors independently associated with a newly diagnosed infection were age ≥80 years, acute coronary syndrome, non-ambulatory status, hyponatremia, anemia, intubation, and patients who were not on loop diuretics as outpatients. The newly diagnosed infection group was associated with a higher incidence of in-hospital mortality (16.3% and 3.2%, <0.001) and excess adjusted risk of in-hospital mortality (odds ratio, 6.07 [95% CI, 3.61-10.19], <0.001) compared with the non-infection group. The newly diagnosed infection group was also associated with a higher 1-year incidence of post-discharge mortality (19.3% in the newly diagnosed infection group and 13.6% in the non-infection group, <0.001) and excess adjusted risk of post-discharge mortality (hazard ratio, 1.49 [95% CI, 1.08-2.07], =0.02) compared with the non-infection group. Conclusions Elderly patients with multiple comorbidities were associated with the development of newly diagnosed infections after admission for acute heart failure. Newly diagnosed infections after admission were associated with higher in-hospital and post-discharge mortality in patients with acute heart failure. Registration URL: https://clinicaltrials.gov; Unique identifier: NCT02334891.
目前尚无研究探讨急性心力衰竭患者入院后新发感染与临床结局之间的关系。本研究旨在探讨急性心力衰竭患者入院后新发感染的相关因素及其与住院和出院后临床结局的关系。
在京都充血性心力衰竭注册研究中，纳入了 4056 例患者，其中 2399 例患者入院时无明显感染性疾病。主要的住院和出院后结局指标为全因死亡。住院期间新发感染 215 例（9.0%），住院期间无感染 2184 例（91.0%）。与新发感染独立相关的因素为年龄≥80 岁、急性冠状动脉综合征、非活动状态、低钠血症、贫血、插管以及门诊未使用襻利尿剂的患者。新发感染组的院内死亡率（16.3%和 3.2%，<0.001）和校正后院内死亡风险（优势比，6.07[95%CI，3.61-10.19]，<0.001）均高于非感染组。新发感染组 1 年出院后死亡率（新发感染组 19.3%，非感染组 13.6%，<0.001）和校正后出院后死亡风险（危险比，1.49[95%CI，1.08-2.07]，=0.02）也高于非感染组。
患有多种合并症的老年患者与急性心力衰竭患者入院后新发感染的发生相关。入院后新发感染与急性心力衰竭患者的住院和出院后死亡率升高相关。
