Ng Tien M H, Oh Esther E, Bae-Shaaw Yuna H, Minejima Emi, Joyce Geoffrey
Department of Clinical Pharmacy and Medicine, University of Southern California, Los Angeles, CA 90089-9121, USA.
Department of Clinical Pharmacy, University of Southern California, Los Angeles, CA 90089-9121, USA.
J Clin Med. 2022 Jan 29;11(3):740. doi: 10.3390/jcm11030740.
Infections are associated with worse short-term outcomes in patients with heart failure (HF). However, acute infections may have lasting pathophysiologic effects that adversely influence HF outcomes after discharge. Our objective was to describe the impact of acute bacterial infections on longitudinal outcomes of patients hospitalized with a primary diagnosis of HF.
This paper is based on a retrospective cohort study of patients hospitalized with a primary diagnosis of HF with or without a secondary diagnosis of acute bacterial infection in Optum Clinformatics DataMart from 2010-2015. Primary outcomes were 30 and 180-day hospital readmissions and mortality, intensive care unit admission, length of hospital stay, and total hospital charge, compared between those with or without an acute infection. Cohorts were compared after inverse probability of treatment weighting. Multivariable logistic regression was used to examine relationship to outcomes. Of 121,783 patients hospitalized with a primary diagnosis of HF, 27,947 (23%) had a diagnosis of acute infection. After weighting, 30-day hospital readmissions [17.1% vs. 15.7%, OR 1.11 (1.07-1.15), < 0.001] and 180-day hospital readmissions [39.6% vs. 38.7%, OR 1.04 (1.01-1.07), = 0.006] were modestly greater in those with an acute infection versus those without. Thirty-day [5.5% vs. 4.3%, OR 1.29 (1.21-1.38), < 0.001] and 180-day mortality [10.7% vs. 9.4%, OR 1.16 (1.11-1.22), < 0.001], length of stay (7.1 ± 7.0 days vs. 5.7 ± 5.8 days, < 0.001), and total hospital charges (USD 62,200 ± 770 vs. USD 51,100 ± 436, < 0.001) were higher in patients with an infection.
The development of an acute bacterial infection in patients hospitalized for HF was associated with an increase in morbidity and mortality after discharge.
感染与心力衰竭（HF）患者更差的短期预后相关。然而，急性感染可能具有持久的病理生理效应，对出院后的HF预后产生不利影响。我们的目的是描述急性细菌感染对以HF为主要诊断住院患者的长期预后的影响。
本文基于一项回顾性队列研究，研究对象为2010 - 2015年在Optum临床信息数据集市中以HF为主要诊断住院且伴有或不伴有急性细菌感染继发诊断的患者。主要结局指标为30天和180天的再入院率和死亡率、重症监护病房入住率、住院时间和总住院费用，对有或无急性感染的患者进行比较。在进行治疗权重的逆概率调整后对队列进行比较。采用多变量逻辑回归分析来检验与结局的关系。在121,783例以HF为主要诊断住院的患者中，27,947例（23%）诊断为急性感染。加权后，有急性感染的患者30天再入院率[17.1%对15.7%，比值比（OR）1.11（1.07 - 1.15），P < 0.001]和180天再入院率[39.6%对38.7%，OR 1.04（1.01 - 1.07），P = 0.006]略高于无急性感染的患者。有感染的患者30天死亡率[5.5%对4.3%，OR 1.29（1.21 - 1.38），P < 0.001]和180天死亡率[10.7%对9.4%，OR 1.16（1.11 - 1.22），P < 0.001]、住院时间（7.1 ± 7.0天对5.7 ± 5.8天，P < 0.001）以及总住院费用（62,200美元±770对51,100美元±436，P < 0.001）均更高。
因HF住院患者发生急性细菌感染与出院后发病率和死亡率增加相关。
