ABC | Volume 110, Nº4, April 2018

Original Article Cardoso et al Infection in patients with heart failure Arq Bras Cardiol. 2018; 110(4):364-370 Table 2 – Comparison of the characteristics of the patients with and without infection Characteristics Infection p* Yes (n = 119) No (n = 141) Age (years) 67.33 ± 12.18 65.03 ± 13.04 0.147 Male sex - n (%) 58 (48.7) 83(58.9) 0.102 Hemoglobin (g/dl) 12.93 ± 1.93 13.25 ± 2.47 0.251 SBP (mm Hg) 100.0 (83.5 – 123.5) 96 (81.5 – 120.0) 0.109 DBP (mm Hg) 61.0 (53.0 – 80.0) 60.0 (56.0 – 76.0) 0.701 HR (bpm) 84.0 (70.0 – 100.0) 80.0 (67.8 – 94.5) 0.493 LVEF (%) 30.0 (25.0 – 46.0) 30 (25.0 – 45.0) 0.019 LVDD (mm) 60.60 ± 10.07 63.24 ± 10.46 0.044 LVSD (mm) 48.72 ± 12.52 52.45 ± 12.74 0.022 Urea (mg/dL) 78.0 (56.0 – 107.0) 79.0 (49.3 – 108.0) 0.391 Creatinine (mg/dL) 1.62 (1.23 – 2.17) 1.54 (1.22 – 2.00) 0.680 Renal failure - n (%) 73 (61.3) 69 (48.9) 0.045 Length of stay (days) 29.43 ± 19.43 21.3 ± 27.89 0.546 Mortality – n (%) Total 42 (35.3) 50 (35.5) 0.977 In-hospital 32 (26.9) 24 (17) 0.050 Post-discharge 10 (11.5%) 26 (22.2%) 0.046 Data are presented as mean ± standard deviation for continuous variables with normal distribution, or median (interquartile range 25% - 75%) for continuous variables with non-normal distribution. Categorical variables are presented as absolute numbers (percentage). P*: To calculate P value, Student t test was used for the variables with normal distribution, Mann-Whitney U test for the variables with non-normal distribution. P value was estimated by use of the chi-square test or Fisher exact test for the categorical variables. SBP: systolic blood pressure; DBP: diastolic blood pressure; HR: heart rate; LVDD: left ventricular diastolic diameter; LVSD: left ventricular systolic diameter; LVEF: left ventricular ejection fraction. had smaller heart dilatation than those without infection, 60.6 mm (10.07) vs 63.4 mm (10.46), p = 0.04. After hospital discharge, patients of the group with infection had better outcome. Mortality during follow-up of those who were hospitalized with infection was 11.5% versus 22.2% of those without infection (p = 0.046). That lower mortality can be attributed to the milder cardiac impairment of those who had infection, a fact that can explain the best outcome after discharge with infection under control. This result shows that infection worsens the prognosis of patients who, even without significant cardiac impairment, decompensate and have a tendency towards worse outcome during hospitalization. Our data confirm that infection worsens the outcome of patients with HF. In addition, in their study, M. Arrigo et al. have also reported similar findings for patients with infection, as well as lower re‑hospitalization rates as compared to those of patients without in-hospital infection. 2 Those data show that infections, by overloading impaired hearts, worsen the clinical findings, leading to decompensation, and such patients with impaired hearts have a worse outcome than those without infection. Once infection is under control, the milder heart impairment of those patients determines their better outcome as compared to those who decompensated without infection, because of their more severe heart impairment. Those findings emphasize the importance of pulmonary infection prevention, avoiding theworsening of patients and their consequent hospitalization. That benefit has been confirmed in octogenarian patients, and those who received vaccination were less frequently hospitalized. 8 Pneumococcal and influenza vaccinations as recommended in our guideline might be very useful to prevent pulmonary infection. Limitations This is an observation study, with its inherent limitations. The patients were selected from those admitted to a tertiary hospital, which might determine the bias of more severe cases. 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. Author contributions Conception and design of the research: Cardoso JN, Del Carlo CH, Ochiai ME, Barretto ACP; Acquisition of 367