Autor(es):
Romano Bruno, R ; Wernly, B ; Wolff, G ; Fjølner, J ; Artigas, A ; Bollen Pinto, B ; Schefold, J ; Kindgen‐Milles, D ; Baldia, P ; Kelm, M ; Beil, M ; Sviri, S ; Heerden, P ; Szczeklik, W ; Topeli, A ; Elhadi, M ; Joannidis, M ; Oeyen, S ; Kondili, E ; Marsh, B ; Andersen, F ; Moreno, R ; Leaver, S ; Boumendil, A ; De Lange, D ; Guidet, B ; Flaatten, H ; Jung, C
Data: 2022
Identificador Persistente: http://hdl.handle.net/10400.17/4473
Origem: Repositório do Centro Hospitalar de Lisboa Central, EPE
Assunto(s): HSJ UCI; COVID-19* / complications; Critical Care; COVID-19* / epidemiology; Chronic Disease; Heart Failure* / complications; Heart Failure* / epidemiology; Humans; Prognosis; Hospitalization; Prospective Studies; Stroke Volume
Descrição
Aims: Chronic heart failure (CHF) is a major risk factor for mortality in coronavirus disease 2019 (COVID-19). This prospective international multicentre study investigates the role of pre-existing CHF on clinical outcomes of critically ill old (≥70 years) intensive care patients with COVID-19. Methods and results: Patients with pre-existing CHF were subclassified as having ischaemic or non-ischaemic cardiac disease; patients with a documented ejection fraction (EF) were subclassified according to heart failure EF: reduced (HFrEF, n = 132), mild (HFmrEF, n = 91), or preserved (HFpEF, n = 103). Associations of heart failure characteristics with the 30 day mortality were analysed in univariate and multivariate logistic regression analyses. Pre-existing CHF was reported in 566 of 3917 patients (14%). Patients with CHF were older, frailer, and had significantly higher SOFA scores on admission. CHF patients showed significantly higher crude 30 day mortality [60% vs. 48%, P < 0.001; odds ratio 1.87, 95% confidence interval (CI) 1.5-2.3] and 3 month mortality (69% vs. 56%, P < 0.001). After multivariate adjustment for confounders (SOFA, age, sex, and frailty), no independent association of CHF with mortality remained [adjusted odds ratio (aOR) 1.2, 95% CI 0.5-1.5; P = 0.137]. More patients suffered from pre-existing ischaemic than from non-ischaemic disease [233 vs. 328 patients (n = 5 unknown aetiology)]. There were no differences in baseline characteristics between ischaemic and non-ischaemic disease or between HFrEF, HFmrEF, and HFpEF. Crude 30 day mortality was significantly higher in HFrEF compared with HFpEF (64% vs. 48%, P = 0.042). EF as a continuous variable was not independently associated with 30 day mortality (aOR 0.98, 95% CI 0.9-1.0; P = 0.128). Conclusions: In critically ill older COVID-19 patients, pre-existing CHF was not independently associated with 30 day mortality.
