IN-HOSPITAL MORTALITY OF HEART FAILURE PATIENTS ASSOCIATED WITH COMMUNITY-ACQUIRED SEPSIS AND HOSPITAL-ACQUIRED SEPSIS

Abstract

Intro: Sepsis is a medical emergency that needs prompt diagnosis and treatment to improve the outcome. Heart failure as a comorbidity increases the challenge in managing septic patients. Reduced ejection fraction in heart failure can increase the mortality rate of septic patients as this condition escalates metabolic demands. To date, there are still limited studies assessing in-hospital mortality of heart failure patients with sepsis. Methods: This is a retrospective study of heart failure patients with sepsis in a tertiary hospital in Indonesia from January 2016 to December 2019. Patients aged ≥ 18 years old and diagnosed with heart failure with sepsis were included in this study, while patients with chronic kidney disease stage V, acute coronary syndrome, malignancy, and HIV/AIDS were excluded. Sepsis is defined as infection associated with two or more systemic inflammatory response syndrome criteria, quick-SOFA ≥ 2, or SOFA score ≥ 7. Sepsis is categorized as either community- or hospital-acquired depending on whether it was diagnosed within 48 hours of the patient's admission. Bivariate and multivariate analysis were used to assess the association of community- and hospital-acquired sepsis with in-hospital mortality. Findings: Ninety-seven patients were included in this study. Most patients were in the 18–60 age group (64.9%) and men (56.7%), with a median length-of-stay of 10 days (1-48 days). The incidence of community-acquired sepsis was higher (68%) than hospital-acquired sepsis (32%). The case fatality rate was 57.7%. Hospital-acquired sepsis was associated with a higher mortality rate compared to community-acquired sepsis [77.5% vs 48.5%, OR 3.63 (95% CI 1.38–9.61)]. After adjusting for age and comorbidity, hospital-acquired sepsis remained strongly associated with in-hospital mortality [adjusted odds ratio (AOR) of 3.53 (95% CI 1.33–9.37)]. Conclusion: Hospital-acquired sepsis is associated with higher risk of in-hospital mortality in heart failure patients compared to community-acquired sepsis.