ABC | Volume 110, Nº4, April 2018

Original Article Infection in Patients with Decompensated Heart Failure: In-Hospital Mortality and Outcome Juliano Novaes Cardoso, Carlos Henrique Del Carlo, Mucio Tavares de Oliveira Junior, Marcelo Eidi Ochiai, Roberto Kalil Filho, Antônio Carlos Pereira Barretto Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brazil Mailing Address: Juliano Novaes Cardoso • Rua Joaquin Ferreira, 147, apto 161 bloco Perdizes. Postal Code 05033-080, Água Branca, São Paulo, SP – Brazil E-mail: julianonc@cardiol.br , juliano.cardoso@incor.usp.br Manuscript received May 11, 2017, revised manuscript September 02, 2017, accepted September 12, 2017 DOI: 10.5935/abc.20180037 Abstract Background: Heart failure (HF) is a syndrome, whose advanced forms have a poor prognosis, which is aggravated by the presence of comorbidities. Objective: We assessed the impact of infection in patients with decompensated HF admitted to a tertiary university- affiliated hospital in the city of São Paulo. Methods: This study assessed 260 patients consecutively admitted to our unit because of decompensated HF. The presence of infection and other morbidities was assessed, as were in-hospital mortality and outcome after discharge. The chance of death was estimated by univariate logistic regression analysis of the variables studied. The significance level adopted was p < 0.05. Results: Of the patients studied, 54.2% were of the male sex, and the mean age ± SD was 66.1 ± 12.7 years. During hospitalization, 119 patients (45.8%) had infection: 88 (33.8%) being diagnosed with pulmonary infection and 39 patients (15.0%), with urinary infection. During hospitalization, 56 patients (21.5%) died, and, after discharge, 36 patients (17.6%). During hospitalization, 26.9% of the patients with infection died vs 17% of those without infection (p = 0.05). However, after discharge, mortality was lower in the group that had infection: 11.5% vs 22.2% (p = 0.046). Conclusions: Infection is a frequent morbidity among patients with HF admitted for compensation of the condition, and those with infection show higher in-hospital mortality. However, those patients who initially had infection and survived had a better outcome after discharge. (Arq Bras Cardiol. 2018; 110(4):364-370) Keywords: Heart Failure / complications; Mortality; Hospitalization; Comorbidity; Lung Diseases / complications; Urinary Tract / physiopathology. Introduction Of the cardiovascular diagnoses, heart failure (HF) is the most frequent cause of hospitalization of patients older than 65 years in Brazil and worldwide. 1,2 Usually HF is controlled at the doctor’s office, but when advanced or associated with any disease or comorbidity, the patients can decompensate, requiring hospitalization. 3 Several factors can contribute to aggravate HF: acute coronary syndrome, arrhythmias and acute respiratory disease were identified as the most common precipitating factors of heart decompensation. 2 In the OPTIMIZE-HF Registry, acute coronary syndrome and acute respiratory disease were associated with higher in-hospital mortality. 4 In the emergency department of our hospital, the factors associated with decompensation were non-adherence to treatment, renal failure, arrhythmias and infections. 5 This study was aimed at analyzing the role of infection in the outcome of patients admitted to our unit, a supporting ward of the emergency department. Methods This is a cohort study assessing 260 patients consecutively admitted to our unit, a supporting ward of the emergency department of the Instituto do Coração (InCor) of the Hospital das Clínicas of the São Paulo University Medical School (HCFMUSP), in 2014 because of decompensated HF. Only the first admission of each patient was considered. All patients had New York Heart Association (NYHA) functional class III or IV HF. They were followed up for up to one year, and underwent clinical, echocardiographic and laboratory assessment. The following data were assessed: identification, heart disease etiology, comorbidities, clinical findings, such as heart rate and blood pressure at the first assessment, hemodynamic clinical profile, and echocardiographic and laboratory findings. The diagnosis of HF was established by use of the Framingham criteria, and type B natriuretic peptide (BNP), in case of diagnostic doubt, in addition to assessment of ejection fraction by use of two-dimensional echocardiography with 364