Pneumonia and inflammation in

acute decompensated heart failure

a registry-based analysis of 1939
patients

Oleh :
dr. Rizki Anindita Pratiwi Matondang
Supv:
Dr.dr.Bintang YM Sinaga, Mked(Paru), SpP(K)
Introduction
• Heart failure is the leading cause of
hospital admission among adults older
than 65 years in western countries
• Several factors have been identified that
may precipitate an episode of acute
decompensated heart failure (ADHF)
• In large registries, respiratory infection
was one of the most prevalent factors
precipitating ADHF occuring in 15% to 29%
of cases
• Diagnosing pneumonia is often challenging in
patients admitted for ADHF as dyspnoea and
rales are cardinal symptoms for both heart
failure and pneumonia
• In this registry-based analysis we aimed to
investigate the prevalence of pneumonia and
predictors for the presence of pneumonia as well
as its association with all cause mortality in
comparison to the inflammation surrogate CRP
in patients admitted with ADHF
Methods
• Analysed data of 1939 patients admitted for ADHF then
were dichotomised according to the presence or absence
of pneumonia
• Patient were included in the analysis if they presented
with ADHF and had a chest radiograph performed within
the first 24 hours after admission
• Categorical patient characteristics were summarised as
frequencies and compared using Pearson’s chi-square
test
• Predictors for pneumonia were identified by logistic
regression analysis
• All statistical tests were two sided and considered
significant if P<0.05 and analyses were using R software
RESULTS
Patient Characteristic
Predictors of Pneumonia
Clinical Outcome
Clinical Outcome
Discussion
• This retrospective cohort study demonstrates that
pneumonia is common in patient admitted for ADHF
• Patient with pneumonia more often had COPD and
pulmonary congestion together with eGFR as
independent predictors for pneumonia. Moreover,
COPD and CKD are known risk factors for CAP
• Pneumonia as precipitating factor was independently
associated in-hospital mortality but not with mid-term
mortality
• Pneumonia is commonly diagnosed based on clinical
features suggestive of acute lower respiratory tract
infection and demonstrable infiltrates on chest
radiograph and often aided by elevated CRP
Limitation
• Due to the retrospective design, our study has several
important limitations

Chest radiographs were only analysed

from clinically driven written reports

Several important characteristics were

not recorded at all or had missing values
Conclusion
• Concomittant pneumonia is relatively common
in patients with ADHF but its diagnosis is
challenging in this setting
• Pneumonia is a marker of all cause mortality and
independently associated with in hospital
mortality
• Inflammation in general seems to be more
important than pneumonia itself for long-term
prognosis
THANK YOU