Impact of Underlying Congestive Heart Failure on In-Hospital Outcomes in Patients with Septic Shock

Purpose: Septic shock (SS) manifests with profound circulatory and cellular metabolism abnormalities and has a high in-hospital mortality (25%-50%). Congestive heart failure (CHF) patients have underlying circulatory dysfunction and compromised cardiac reserve that may place them at increased risk if they develop sepsis. Outcomes in patients with CHF who are admitted with SS have not been well studied. Materials and Method: Retrospective cross sectional secondary analysis of the Nationwide Readmission Database (NRD) for 2016 and 2017. ICD-10 codes were used to identify patients with SS during hospitalization, and then the cohort was dichotomized into those with and without an underlying diagnosis of CHF. Results: Propensity match analyses were performed to evaluate in-hospital mortality and clinical cardiovascular outcomes in the 2 groups. Cardiogenic shock patients were excluded from the study. A total of 578,629 patients with hospitalization for SS were identified, of whom 19.1% had a coexisting diagnosis of CHF. After propensity matching, 81,699 individuals were included in the comparative groups of SS with CHF and SS with no CHF. In-hospital mortality (35.28% vs 32.50%, P < .001), incidence of ischemic stroke (2.71% vs 2.53%, P = .0032), and acute kidney injury (69.9% vs 63.9%, P = .001) were significantly higher in patients with SS and CHF when compared to those with SS and no CHF. Conclusions: This study identified CHF as a strong adverse prognosticator for inpatient mortality and several major adverse clinical outcomes. Study findings suggest the need for further investigation into these findings’ mechanisms to improve outcomes in patients with SS and underlying CHF.

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Impact of acute kidney injury on in-hospital outcomes among patients hospitalized with acute heart failure: a propensity score matched analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.1247 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Shetty ◽

H Malik ◽

A Abbas ◽

Y Ying ◽

W Aronow ◽

...

Keyword(s):

Heart Failure ◽

Acute Kidney Injury ◽

Propensity Score ◽

Hospital Mortality ◽

Acute Heart Failure ◽

Kidney Injury ◽

Matched Cohort ◽

Hospital Outcomes ◽

Increased Risk ◽

The Impact

Abstract Background Acute kidney injury (AKI) is frequently present in patients admitted for acute heart failure (AHF). Several studies have evaluated the mortality risk and have concluded poor prognosis in any patient with AKI admitted for AHF. For the most part, the additional morbidity and mortality burden in AHF patients with AKI has been attributed to the concomitant comorbidities, and/or interventions. Purpose We sought to determine the impact of acute kidney injury (AKI) on in-hospital outcomes in patients presenting with acute heart failure (AHF). We identified isolated AKI patients after excluding other concomitant diagnoses and procedures, which may contribute to an increased risk of mortality and morbidity. Methods Data from the National Inpatient Sample (2012- 14) were used to identify patients with the principal diagnosis of AHF and the concomitant secondary diagnosis of AKI. Propensity score matching was performed on 30 baseline variables to identify a matched cohort. The outcome of interest was in-hospital mortality. We further evaluated in-hospital procedures and complications. Results Of 1,470,450 patients admitted with AHF, 24.3% had AKI. After propensity matching a matched cohort of 356,940 patients was identified. In this matched group, the AKI group had significantly higher in-hospital mortality (3.8% vs 1.7%, p<0.001). Complications such as sepsis and cardiac arrest were higher in the AKI group. Similarly, in-hospital procedures including CABG, mechanical ventilation and IABP were performed more in the AKI group. AHF patients with AKI had longer in-hospital stay of ∼1.7 days. Conclusions In a propensity score-matched cohort of AHF with and without AKI, the risk of in-hospital mortality was >2-fold in the AKI group. Healthcare utilization and burden of complications were higher in the AKI group. Funding Acknowledgement Type of funding source: None

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Risk Factors for Development of Septic Shock in Patients with Urinary Tract Infection

BioMed Research International ◽

10.1155/2015/717094 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 8

Author(s):

Chih-Yen Hsiao ◽

Huang-Yu Yang ◽

Chih-Hsiang Chang ◽

Hsing-Lin Lin ◽

Chao-Yi Wu ◽

...

Keyword(s):

Heart Failure ◽

Septic Shock ◽

Congestive Heart Failure ◽

Acute Kidney Injury ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Kidney Injury ◽

Subsequent Treatment ◽

Care Hospital

Introduction. Severe sepsis and septic shock are associated with substantial mortality. However, few studies have assessed the risk of septic shock among patients who suffered from urinary tract infection (UTI).Materials and Methods. This retrospective study recruited UTI cases from an acute care hospital between January 2006 and October 2012 with prospective data collection.Results. Of the 710 participants admitted for UTI, 80 patients (11.3%) had septic shock. The rate of bacteremia is 27.9%; acute kidney injury is 12.7%, and the mortality rate is 0.28%. Multivariable logistic regression analyses indicated that coronary artery disease (CAD) (OR: 2.521, 95% CI: 1.129–5.628,P=0.024), congestive heart failure (CHF) (OR: 4.638, 95% CI: 1.908–11.273,P=0.001), and acute kidney injury (AKI) (OR: 2.992, 95% CI: 1.610–5.561,P=0.001) were independently associated with septic shock in patients admitted with UTI. In addition, congestive heart failure (female, OR: 4.076, 95% CI: 1.355–12.262,P=0.012; male, OR: 5.676, 95% CI: 1.103–29.220,P=0.038, resp.) and AKI (female, OR: 2.995, 95% CI: 1.355–6.621,P=0.007; male, OR: 3.359, 95% CI: 1.158–9.747,P=0.026, resp.) were significantly associated with risk of septic shock in both gender groups.Conclusion. This study showed that patients with a medical history of CAD or CHF have a higher risk of shock when admitted for UTI treatment. AKI, a complication of UTI, was also associated with septic shock. Therefore, prompt and aggressive management is recommended for those with higher risks to prevent subsequent treatment failure in UTI patients.

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Clinical Outcomes of Malignancy-Related Neutropenic Fever Admissions in the United States: A 10-Year National Study

Blood ◽

10.1182/blood-2020-138490 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 43-44

Author(s):

Moataz Ellithi ◽

Hafez M Abdullah ◽

Waqas Ullah ◽

Radowan Elnair ◽

Fouad Khalil ◽

...

Keyword(s):

Heart Failure ◽

Chronic Kidney Disease ◽

Septic Shock ◽

Acute Kidney Injury ◽

Respiratory Failure ◽

Febrile Neutropenia ◽

Hospital Mortality ◽

Kidney Injury ◽

Neutropenic Fever ◽

Source Of Infection

Background: Neutropenia and neutropenic fever are a major cause of in-hospital morbidity and mortality in cancer patients. In this study, we aim to analyze trends in hospital outcomes of cancer-related neutropenic fever admissions and investigate clinical predictors associated with outcomes. Methods: We queried the National Inpatient Sample (NIS) database (2008-2017), using ICD-9 and ICD-10 codes accordingly, to identify cancer-related neutropenic fever admissions in the US hospitals. Cases younger than 18 years of age and cases that did not have malignancy as a primary or secondary diagnosis were excluded. Baseline characteristics of survivors were compared with non-survivors. Statistical analysis was performed using SPSS v26 (IBM Corp, Armonk, NY, USA). The adjusted odds ratio (aOR) and 95% confidence interval (CI) were calculated using the Cochran-Mantel-Haenszel test. A multivariate regression model was deployed to assess predictors of inpatient mortality. Complex weights were used throughout all calculations, enabling appropriate national projections. Results: A total of 159,065 records were identified using our inclusion and exclusion criteria, corresponding to 778,427 admissions nationally. The in-hospital mortality rate for all patients was 5.9%. Most common documented sources of infections were respiratory (24.3%), followed by urinary tract infections (13.2%), intraabdominal infections (7.6%), and skin and soft tissue infections (7.1%). Overall, sepsis was present in about quarter of the admissions, while acute kidney injury and respiratory failure were also prevalent (13.2% and 6.9%, respectively). On regression analysis, older age (OR 1.026; 95% CI, 1.025 - 1.027; P <0.001), heart failure (OR 1.90; 95% CI, 1.84 - 1.96; P <0.001), liver disease (OR 1.64; 95% CI, 1.56 - 1.72; P <0.001), chronic kidney disease (OR 1.325 95% CI, 1.30 - 1.39; P <0.001), coagulopathy (OR 1.67; 95% CI, 1.64-1.71; P <0.001), and metastatic disease (OR 1.70; 95% CI, 1.65- 1.74; P <0.001), were independent predictors of increased in-hospital mortality among patients admitted with febrile neutropenia, whereas female sex was associated with relatively favorable outcome (OR 0.93; 0.92-0.95; P <0.001). Based on the source of infection that was documented during admission, we found respiratory infections (OR 1.27; 95% CI, 1.24-1.30; P <0.001), meningoencephalitis (OR 1.23; 95% CI, 1.12-1.36; P <0.001), and systemic mycosis (OR 1.28; 95% CI, 1.24-1.32; P <0.001) were associated with worse outcome, while patients who had urinary (OR 0.75; 95% CI, 0.72-0.78; P <0.001) or soft tissue source of infection (OR 0.75; 95% CI, 0.71-0.79; P <0.001), or neutropenic enterocolitis (OR 0.91; 95% CI, 0.84-0.98; P <0.001) had a relatively better outcome. In terms of complications during admission, we found the occurrence of acute kidney injury (OR 2.13; 95% CI, 2.07-2.18; P <0.001), sepsis (OR 2.39; 95% CI, 2.32-2.45; P <0.001), septic shock (OR 3.25; 95% CI, 3.14-3.35; P <0.001), acute encephalopathy (OR 1.71 95% CI, 1.63-1.79; P <0.001), and acute respiratory failure (OR 9.98; 95% CI, 9.71-10.24; P <0.001) were associated with higher mortality. Conclusion: Despite the advances in risk stratification and frequent use of unified protocols that incorporate prophylactic growth factors in the therapeutic regimens, incidence of in-hospital mortality of febrile neutropenia appears to be unchanged over the decade between 2008 and 2017. We identified older age, metastatic disease, presence of chronic heart failure, liver disease, chronic kidney disease, coagulopathy, presence of acute kidney injury, sepsis, acute respiratory failure, encephalopathy, and septic shock as independent predictors of increased in-hospital mortality among patients admitted with febrile neutropenia. Further studies are needed to further explore predictors of poor outcomes in those patients. Figure Disclosures Anwer: Incyte, Seattle Genetics, Acetylon Pharmaceuticals, AbbVie Pharma, Astellas Pharma, Celegene, Millennium Pharmaceuticals.: Honoraria, Research Funding, Speakers Bureau.

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Abstract 113: Readmission Rates and Causes for In-Hospital Cardiac Arrest Survivors at 30 and 180 Days: Insights from Nationwide Readmission Database

Circulation ◽

10.1161/circ.140.suppl_2.113 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Ahmed Elkaryoni ◽

Paul Chan

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Cardiac Arrest ◽

Hospital Discharge ◽

Readmission Rates ◽

Common Cause ◽

Icd 10 ◽

Nationwide Readmission Database ◽

Hospital Cardiac Arrest ◽

Over Time

Introduction: Rates of survival to discharge for patients with in-hospital cardiac arrest (IHCA) have improved over the past 2 decades from 13% in 2000 to 25% in 2016. Yet, little is known about rates and causes of readmissions among those survivors. We sought to investigate early and late rates and causes of readmission for IHCA survivors at 30 and 180 days after discharge. Methods: Within the Nationwide Readmission Database (NRD), we identified patients 18 years of age or older who survived to hospital discharge after an IHCA between 2010 and 2016. IHCA was defined by an ICD-9 or ICD-10 diagnosis code (cardiac arrest, ventricular fibrillation or flutter) combined with a procedure code (defibrillation or external chest compression). We evaluated rates and causes of 30 and 180 days readmission and examined whether these have changed over time. Results: A total of 86,140 patients had an IHCA and survived to hospital discharge. Overall, mean age was 64.3 ± 14.9, women were 40.1%, and the mean length of stay was 15.1 ±17.9 days. All-cause readmission rates at 30 and 180 days were 22.7% and 69.9%, respectively. Readmission rates decreased over time. Thirty-day readmission rates decreased from 23.8% in 2010 to 21.1% in 2016, and 180-day readmission rates decreased from 76.1% to 63.6%. (Figure) Among readmitted patients, 13.5% were readmitted more than once at 30 days and 44.9% were readmitted more than once at 180 days. The most common cause of 30-day readmissions were congestive heart failure (11.7%), infection/septicemia (11.4%), and cardiac dysrhythmias (5.3%),whereas the top causes of 180-day readmissions were congestive heart failure (11.9%), infection/septicemia (11.3%), and respiratory insufficiency, or device complications (4.6%). Conclusion: All-cause readmission rates for IHCA survivors at 30 and 180 days have decreased over time, Congestive heart failure is the most common cause of readmissions but accounts for only 11.7% and 11.9% of readmissions at 30 and 180 days.

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Biochemical Markers in Patients with Readmission for Congestive Heart Failure

Revista de Chimie ◽

10.37358/rc.18.7.6395 ◽

2018 ◽

Vol 69 (7) ◽

pp. 1687-1691

Author(s):

Razan Al Namat ◽

Mihai Constantin ◽

Ionela Larisa Miftode ◽

Andrei Manta ◽

Antoniu Petris ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Rural Areas ◽

Discharge Planning ◽

Difficult Problem ◽

Uncontrolled Hypertension ◽

Medical Attention ◽

Family Doctors ◽

Increased Risk ◽

Risk Patients

Repetitive or recurrent hospitalizations are a general major health issue in patients with chronic disease. Congestive heart failure, is associated with a high incidence and presence of early rehospitalization, but variables in order to identify patients at increased risk and also an analysis of potentially remediable factors contributing to readmission have not been previously reported and it remains still a difficult problem. We retrospectively assessed 100 patients aged between 48-85 years old, of which 75% were men, who had been hospitalized with documentation of congestive heart failure in St. Spiridon County Emergency Hospital. They were hospitalized between 2010-2017. Even if recurrent heart failure was the most common cause for readmission or rehospitalization, other cardiac disorders and noncardiac illnesses were also accounted for readmission. Predictive factors of an increased probability of readmission included prior patient�s medical heart failure history, heart failure decompensation precipitated or accelerated by an ischaemic episode, atrial fibrillation or uncontrolled hypertension. Factors contributing to preventable readmissions included noncompliance with medications or diet, inadequate discharge planning or follow-up, failure of both social support system and the seek of a promp medical attention when symptoms reappeared. We also identified an inappropriate colaboration with family doctors especially for the patients from rural areas. Patients were more likely to cite side effects of prescribed medications rather than nonadherence as a precipitating factor for readmission. Thus, we can appreciate that early rehospitalization in patients with congestive heart failure may be avoidable in up to 50% of cases. Identification of high risk patients is possible and also necessary shortly after admission in order to identify nonpharmacological interventions designed to decrease readmission frequency.

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A simple nomogram to predict contrast-induced acute kidney injury in patients with congestive heart failure undergoing coronary angiography

European Heart Journal ◽

10.1093/ehjci/ehaa946.2554 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L Lei ◽

Y He ◽

Z Guo ◽

B Liu ◽

J Liu ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Acute Kidney Injury ◽

Coronary Angiography ◽

Prediction Models ◽

Validation Cohort ◽

Kidney Injury ◽

Class Ii ◽

Functional Class ◽

Killip Class

Abstract Background Patients with congestive heart failure (CHF) are vulnerable to contrast-induced acute kidney injury (CI-AKI), but few prediction models are currently available. Objectives We aimed to establish a simple nomogram for CI-AKI risk assessment for patients with CHF undergoing coronary angiography. Methods A total of 1876 consecutive patients with CHF (defined as New York Heart Association functional class II-IV or Killip class II-IV) were enrolled and randomly (2:1) assigned to a development cohort and a validation cohort. The endpoint was CI-AKI defined as serum creatinine elevation of ≥0.3 mg/dL or 50% from baseline within the first 48–72 hours following the procedure. Predictors for the nomogram were selected by multivariable logistic regression with a stepwise approach. The discriminative power was assessed using the area under the receiver operating characteristic (ROC) curve and was compared with the classic Mehran score in the validation cohort. Calibration was assessed using the Hosmer–Lemeshow test and 1000 bootstrap samples. Results The incidence of CI-AKI was 9.06% (n=170) in the total sample, 8.64% (n=109) in the development cohort and 9.92% (n=61) in the validation cohort (p=0.367). The simple nomogram including four predictors (age, intra-aortic balloon pump, acute myocardial infarction and chronic kidney disease) demonstrated a similar predictive power as the Mehran score (area under the curve: 0.80 vs 0.75, p=0.061), as well as a well-fitted calibration curve. Conclusions The present simple nomogram including four predictors is a simple and reliable tool to identify CHF patients at risk of CI-AKI, whereas further external validations are needed. Figure 1 Funding Acknowledgement Type of funding source: None

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Incidence, Risk Factors and Outcomes of New Onset Supraventricular Arrhythmias in African American Patients with Severe Sepsis

Ethnicity & Disease ◽

10.18865/ed.26.2.205 ◽

2016 ◽

Vol 26 (2) ◽

pp. 205 ◽

Cited By ~ 6

Author(s):

O'Dene Lewis ◽

Julius Ngwa ◽

Richard F. Gillum ◽

Alicia Thomas ◽

Wayne Davis ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Congestive Heart Failure ◽

Severe Sepsis ◽

Intensive Care ◽

Respiratory Failure ◽

Hospital Mortality ◽

Supraventricular Arrhythmias ◽

Incidence Risk ◽

New Onset

Purpose: New onset supraventricular arrhythmias (SVA) are commonly reported in mixed intensive care settings. We sought to determine the incidence, risk factors and outcomes of new onset SVA in African American (AA) patients with severe sepsis admitted to medical intensive care unit (MICU).Methods: Patients admitted to MICU between January 2012 through December 2012 were studied. Patients with a previous history of arrhythmia or with new onset of ventricular arrhythmia were excluded. Data on risk factors, critical care interventions and outcomes were obtained.Results: One hundred and thirty-one patients were identified. New onset SVA occurred in 34 (26%) patients. Of those 34, 20 (59%) had atrial fibrillation (AF), 6 (18%) had atrial flutter and 8 (24%) had other forms of SVA. Compared with patients without SVA, patients with new onset SVA were older (69 ± 12 yrs vs 59 ± 13 yrs, P=.003), had congestive heart failure (47% vs 24%, P=.015) and dyslipidemia (41% vs 15%, P=.002). Additionally, they had a higher mean mortality prediction model (MPM II) score (65 ± 25 vs 49 ± 26, P=.001) and an increased incidence of respiratory failure (85% vs 55%, P=.001). Hospital mortality in patients with new onset SVA was 18 (53%) vs 30 (31%); P=.024; however, in a multivariate analysis, new onset SVA was associated with nonsignificantly increased odds (OR 2.58, 95% CI 0.86-8.05) for in-hospital mortality.Conclusion: New onset SVA was prevalent in AA patients with severe sepsis and occurred more frequently with advanced age, increased severity of illness, congestive heart failure, and acute respiratory failure; it was associated with higher unadjusted in hospital mortality. However, after multiple adjustments, new onset SVA did not remain an independent predictor of mortality. Ethn Dis.2016;26(2):205-212; doi:10.18865/ ed.26.2.205

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Overt acts of perceived discrimination reported by British working-age adults with and without disability

Journal of Public Health ◽

10.1093/pubmed/fdz093 ◽

2019 ◽

Cited By ~ 1

Author(s):

Eric Emerson ◽

Allison Milner ◽

Zoe Aitken ◽

Lauren Krnjacki ◽

Cathy Vaughan ◽

...

Keyword(s):

Public Health ◽

Negative Impact ◽

Policy Research ◽

Secondary Analysis ◽

People With Disabilities ◽

Public Health Problem ◽

Health Staff ◽

Cross Sectional ◽

Increased Risk ◽

The Uk

Abstract Background Exposure to discrimination can have a negative impact on health. There is little robust evidence on the prevalence of exposure of people with disabilities to discrimination, the sources and nature of discrimination they face, and the personal and contextual factors associated with increased risk of exposure. Methods Secondary analysis of de-identified cross-sectional data from the three waves of the UK’s ‘Life Opportunities Survey’. Results In the UK (i) adults with disabilities were over three times more likely than their peers to be exposed to discrimination, (ii) the two most common sources of discrimination were strangers in the street and health staff and (iii) discrimination was more likely to be reported by participants who were younger, more highly educated, who were unemployed or economically inactive, who reported financial stress or material hardship and who had impairments associated with hearing, memory/speaking, dexterity, behavioural/mental health, intellectual/learning difficulties and breathing. Conclusions Discrimination faced by people with disabilities is an under-recognised public health problem that is likely to contribute to disability-based health inequities. Public health policy, research and practice needs to concentrate efforts on developing programs that reduce discrimination experienced by people with disabilities.

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Abstract 16010: Congestive Heart Failure and Coronavirus Disease 2019 Illness Severity

Circulation ◽

10.1161/circ.142.suppl_3.16010 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Max Ruge ◽

Joanne Michelle D Gomez ◽

Gatha G Nair ◽

Setri Fugar ◽

Jeanne du Fay de Lavallaz ◽

...

Keyword(s):

Heart Failure ◽

At Risk ◽

Congestive Heart Failure ◽

Case Fatality ◽

Severity Of Illness ◽

Severe Infection ◽

Severe Illness ◽

Increased Risk ◽

History Of ◽

Male Sex

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has killed hundreds of thousands worldwide. Those with cardiovascular disease represent a vulnerable population with higher risk for contracting COVID-19 and worse prognosis with higher case fatality rates. Congestive heart failure (CHF) may lead to worsening COVID-19 symptoms. However, it is unclear if CHF is an independent risk factor for severe COVID-19 infection or if other accompanying comorbidities are responsible for the increased risk. Methods: From March to June 2020, data was obtained from adult patients diagnosed with COVID-19 infection who were admitted in the Rush University System for Health (RUSH) in Illinois. Heart failure patients, determined by ICD code assignments extracted from the electronic medical records, were identified. Multivariable logistic regression was performed between predictor variables and a composite outcome of severe infection consisting of Intensive Care Unit (ICU) admission, intubation, or in-hospital mortality. Results: In this cohort (n=1136), CHF [odds ratio (OR) 1.02] alone did not predict a more severe illness. Prior myocardial infarction [(MI), OR 3.55], history of atrial fibrillation [(AF), OR 2.14], and male sex (OR 1.55) were all significantly (p<0.001) associated with more severe COVID-19 illness course when controlling for CHF (Figure 1). In the 178 CHF patients, more advanced age (68.8 years vs. 63.8 years; p<0.05) and female sex (54.5% vs. 39.1%; p<0.05) were associated with increased severity of illness. Conclusions: Prior MI, history of AF, and male sex predicted more severe COVID-19 illness course in our cohort, but pre-existing heart failure alone did not. However, CHF patients who are females and older in age are at risk for severe infection. These findings help clinicians identify patients with comorbidities early at risk for severe COVID-19 illness.

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