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Prevalence, Determinants, and Prognostic Significance of Hospital Acquired Pneumonia in Patients with Acute Heart Failure

The prognostic impact of hospital-acquired pneumonia (HAP) in acute heart failure (AHF) patients have not been fully elucidated. We evaluated 776 consecutive hospitalized AHF patients. The primary in-hospital outcomes were all-cause death and worsening heart failure (WHF), while the outcome followin...

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Detalles Bibliográficos
Autores principales: Tada, Atsushi, Omote, Kazunori, Nagai, Toshiyuki, Honda, Yasuyuki, Nakano, Hiroki, Honda, Satoshi, Iwakami, Naotsugu, Hamatani, Yasuhiro, Nakai, Michikazu, Nishimura, Kunihiro, Asaumi, Yasuhide, Aiba, Takeshi, Noguchi, Teruo, Kusano, Kengo, Yokoyama, Hiroyuki, Yasuda, Satoshi, Ogawa, Hisao, Anzai, Toshihisa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408712/
https://www.ncbi.nlm.nih.gov/pubmed/32668753
http://dx.doi.org/10.3390/jcm9072219
Descripción
Sumario:The prognostic impact of hospital-acquired pneumonia (HAP) in acute heart failure (AHF) patients have not been fully elucidated. We evaluated 776 consecutive hospitalized AHF patients. The primary in-hospital outcomes were all-cause death and worsening heart failure (WHF), while the outcome following discharge was all-cause death. The clinical diagnosis of HAP was based on clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Patients with HAP had a significantly higher incidence of in-hospital death (12% vs. 1%, p < 0.001), WHF during the hospitalization (28% vs. 7%, p < 0.001), and longer length of hospital stay (p = 0.003) than those without. Among patients who survived at discharge, during a median follow-up period of 741 (interquartile range 422–1000) days, the incidence of all-cause death was significantly higher in patients with HAP than in those without (p < 0.001). In the multivariable Cox regression, HAP development was independently associated with all-cause death after discharge (HR [hazard ratio] 1.86, 95%CI [confidence interval] 1.08–3.19). Furthermore, older age (OR [odds ratio] 1.04, 95%CI 1.01–1.08), male sex (OR 2.21, 95%CI 1.14–4.28), and higher serum white blood cell count (OR 1.18, 95%CI 1.09–1.29) and serum C-reactive protein (OR 1.08, 95%CI 1.01–1.06) were independently associated with HAP development. In hospitalized patients with AHF, HAP development was associated with worse clinical outcomes, suggesting the importance of prevention and early screening for HAP.