PDF(Pubmed)
Abstract：
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
摘要：
■重症监护病房（ICU）因急性心力衰竭（AHF）入院的患者医院获得性肺炎（HAP）的预测因素和预后的数据很少。更好地了解这些因素可以为管理策略提供信息。本研究旨在评估ICU中AHF住院患者HAP的发生率和预测因素及其对管理和预后的影响。
■这是一项回顾性单中心观察性研究。从匿名的基于注册表的数据集中收集患者水平和结果数据。主要结局是院内全因死亡率，次要结局包括住院时间（LOS），对肌力/通气支持的要求，和出院时心力衰竭（HF）药物类别的处方模式。
■638例AHF患者（平均年龄，71.6±12.7年，61.9%男性），137例发生HAP（21.5%）。在多变量分析中，HAP是由从头AHF预测的，较高的NT前B型利钠肽水平，胸片上的胸腔积液，二尖瓣反流,有中风史,糖尿病,和慢性肾病。HAP患者的LOS较长，和更大的可能性需要斜切物(调整后的赔率比，OR,2.31，95%置信区间，CI，2.16-2.81；p<0.001）或通气支持（校正OR2.11，95CI，1.76-2.79，p<0.001）。在调整了年龄之后,性和临床协变量，HAP患者的全因住院死亡率明显更高(风险比，2.10；95CI，1.71-2.84；p<0.001）。从HAP恢复的患者在出院时接受HF药物的可能性较小。
■HAP在ICU环境中的AHF患者中很常见，在从头AHF患者中更为普遍。二尖瓣反流,更高的合并症负担，更严重的拥堵。HAP赋予更大的并发症和院内死亡风险，出院时接受循证HF药物治疗的可能性较低。
■这是一项回顾性单中心观察性研究。从匿名的基于注册表的数据集中收集患者水平和结果数据。主要结局是院内全因死亡率，次要结局包括住院时间（LOS），对肌力/通气支持的要求，和出院时心力衰竭（HF）药物类别的处方模式。
■638例AHF患者（平均年龄，71.6±12.7年，61.9%男性），137例发生HAP（21.5%）。在多变量分析中，HAP是由从头AHF预测的，较高的NT前B型利钠肽水平，胸片上的胸腔积液，二尖瓣反流,有中风史,糖尿病,和慢性肾病。HAP患者的LOS较长，和更大的可能性需要斜切物(调整后的赔率比，OR,2.31，95%置信区间，CI，2.16-2.81；p<0.001）或通气支持（校正OR2.11，95CI，1.76-2.79，p<0.001）。在调整了年龄之后,性和临床协变量，HAP患者的全因住院死亡率明显更高(风险比，2.10；95CI，1.71-2.84；p<0.001）。从HAP恢复的患者在出院时接受HF药物的可能性较小。
■HAP在ICU环境中的AHF患者中很常见，在从头AHF患者中更为普遍。二尖瓣反流,更高的合并症负担，更严重的拥堵。HAP赋予更大的并发症和院内死亡风险，出院时接受循证HF药物治疗的可能性较低。
