Prevalence, determinants, and prognostic significance of hospital acquired pneumonia in patients with acute heart failure

Atsushi Tada, Kazunori Omote, Toshiyuki Nagai, Yasuyuki Honda, Hiroki Nakano, Satoshi Honda, Naotsugu Iwakami, Yasuhiro Hamatani, Michikazu Nakai, Kunihiro Nishimura, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Hiroyuki Yokoyama, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article number2219
Pages (from-to)1-13
Number of pages13
JournalJournal of Clinical Medicine
Volume9
Issue number7
DOIs
Publication statusPublished - 2020 Jul
Externally publishedYes

Keywords

  • Acute heart failure
  • Hospital‐acquired pneumonia
  • Prognosis

ASJC Scopus subject areas

  • Medicine(all)

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