Key result
In patients presenting to the emergency department with sepsis, the presence of heart failure with preserved ejection fraction did not significantly increase in-hospital mortality compared to patients without heart failure (OR 1.21).
Why the study?
Patients with HFpEF may face a higher risk of mortality from sepsis than patients without HFpEF, prompting a comparison of sepsis-related morbidity and mortality between these groups.
Does the presence of HFpEF increase in-hospital mortality in septic patients presenting to the emergency department compared to patients without heart failure?
Cohort (n=1,092)
No
Does the presence of HFpEF increase in-hospital mortality in septic patients presenting to the emergency department compared to patients without heart failure?
In septic patients presenting to the emergency department, the presence of HFpEF is associated with significantly higher early ED mortality and intubation rates, despite similar overall in-hospital mortality compared to patients without heart failure.
Background: Patients with heart failure with preserved ejection fraction (HFpEF) may be at a higher risk of mortality from sepsis than patients without HFpEF. Objective: The aim of this study is to compare sepsis-related morbidity and mortality between patients with HFpEF and patients without heart failure presenting to the emergency department (ED) of a tertiary medical center. Design: Single-center retrospective cohort study conducted at an academic ED between January 1, 2014 and December 31, 2018. Patients: Patients with a diagnosis of sepsis were included. Main Measures: Bivariate and multivariate analyses were performed on the demographics, characteristics and outcomes of patients with sepsis. The primary outcome of the study was in-hospital mortality. Secondary outcomes included ED mortality, lengths of stays and differences in interventions between the two groups. Key Results: A total of 1381 patients presented with sepsis to the ED, of which 305 (22.08%) had HFpEF. There was no significant difference in in-hospital mortality between the two groups (40.7% vs 37.4%; p-value=0.314). However, there was a significant increase in ED mortality for septic HFpEF patients compared to controls (2.4% vs 0.4%; p-value=0.003). Septic HFpEF patients presenting to the ED were older than control patients (76.84 vs 68.44 years old; p-value<0.0001). On the other hand, there was no significant increase in the use of norepinephrine, dopamine, epinephrine or dobutamine in the first 24h between the two groups. There was a significantly higher rate of intubation in the first 48h for septic patients with HFpEF (17.5% vs 8.9%; p-value<0.0001). Finally, there was significantly less intravenous fluid requirement at 6h (1.94L vs 2.41L;p-value<0.0001) and 24h (3.11L vs 3.54L; p-value = 0.004) for septic patients with HFpEF compared to controls. Conclusion: Septic HFpEF patients experienced an increase in ED mortality, intubation and steroid use compared to septic patients without HFpEF.
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Chebl et al. (2020) conducted a cohort in Sepsis (n=1,092). Heart failure with preserved ejection fraction (HFpEF) vs. No heart failure was evaluated on In-hospital mortality (OR 1.21, 95% CI 0.90-1.62, p=0.21). In patients presenting to the emergency department with sepsis, the presence of heart failure with preserved ejection fraction did not significantly increase in-hospital mortality compared to patients without heart failure (OR 1.21).
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