Predictors and prognostic implications of hospital-acquired pneumonia in patients admitted for acute heart failure

Marija Polovina; Milenko Tomić; Mihajlo Viduljević; Nataša Zlatić; Andrea Stojićević; Danka Civrić; Aleksandra Milošević; Gordana Krljanac; Ratko Lasica; Milika Ašanin

doi:10.3389/fcvm.2023.1254306

Predictors and prognostic implications of hospital-acquired pneumonia in patients admitted for acute heart failure

Front Cardiovasc Med. 2023 Sep 15:10:1254306. doi: 10.3389/fcvm.2023.1254306. eCollection 2023.

Authors

Marija Polovina^{1

2}, Milenko Tomić¹, Mihajlo Viduljević¹, Nataša Zlatić¹, Andrea Stojićević¹, Danka Civrić¹, Aleksandra Milošević^{1

2}, Gordana Krljanac^{1

2}, Ratko Lasica^{1

2}, Milika Ašanin^{1

2}

Affiliations

¹ Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia.
² Faculty of Medicine, University of Belgrade, Belgrade, Serbia.

Abstract

Introduction: Data on predictors and prognosis of hospital acquired pneumonia (HAP) in patients admitted for acute heart failure (AHF) to intensive care units (ICU) are scarce. Better knowledge of these factors may inform management strategies. This study aimed to assess the incidence and predictors of HAP and its impact on management and outcomes in patients hospitalised for AHF in the ICU.

Methods: this was a retrospective single-centre observational study. Patient-level and outcome data were collected from an anonymized registry-based dataset. Primary outcome was in-hospital all-cause mortality and secondary outcomes included length of stay (LOS), requirement for inotropic/ventilatory support, and prescription patterns of heart failure (HF) drug classes at discharge.

Results: Of 638 patients with AHF (mean age, 71.6 ± 12.7 years, 61.9% male), HAP occurred in 137 (21.5%). In multivariable analysis, HAP was predicted by de novo AHF, higher NT proB-type natriuretic peptide levels, pleural effusion on chest x-ray, mitral regurgitation, and a history of stroke, diabetes, and chronic kidney disease. Patients with HAP had a longer LOS, and a greater likelihood of requiring inotropes (adjusted odds ratio, OR, 2.31, 95% confidence interval, CI, 2.16-2.81; p < 0.001) or ventilatory support (adjusted OR 2.11, 95%CI, 1.76-2.79, p < 0.001). After adjusting for age, sex and clinical covariates, all-cause in-hospital mortality was significantly higher in patients with HAP (hazard ratio, 2.10; 95%CI, 1.71-2.84; p < 0.001). Patients recovering from HAP were less likely to receive HF medications at discharge.

Discussion: HAP is frequent in AHF patients in the ICU setting and more prevalent in individuals with de novo AHF, mitral regurgitation, higher burden of comorbidities, and more severe congestion. HAP confers a greater risk of complications and in-hospital mortality, and a lower likelihood of receiving evidence-based HF medications at discharge.

Keywords: acute heart failure; heart failure treatment; hospital acquired pneumonia; intensive care unit; mortality.