In the Journals

Death from sepsis common, possibly preventable in patients with chronic HFrEF

Sepsis is a leading cause of death in people with chronic HF with reduced left ventricular ejection fraction and may be preventable, according to a study published in the Journal of the American Heart Association.

“A key finding of our study is the distinct contribution of baseline patient characteristics to the prediction of sepsis, other noncardiovascular, progressive heart failure and sudden cardiac death,” Andrew M. N. Walker, MBChB, PhD, of the Leeds Institute of Cardiovascular and Metabolic Medicine at the University of Leeds, U.K., and colleagues wrote. “This implies that sepsis is a distinct mode of death and not simply a misclassification of other modes of death. Perhaps more importantly, by showing unique/specific risk markers for each mode of death, our observations suggest that more nuanced risk prediction could guide targeted interventions to improve survival.”

To investigate the prevalence of death from sepsis in patients with chronic HFrEF and to determine its risk marker profile, researchers conducted a prospective cohort study of 1,802 patients with chronic HF and LVEF of 45% or less who attended specialist cardiology clinics in four U.K. hospitals between 2006 and 2014.

Modes of death were categorized as sudden cardiac, progressive HF, other CV death or non-CV death. There was a final censorship date of May 8, 2016.

Patients were followed up during a 10.3-year period (mean, 4 years), during which 737 deaths occurred (progressive HF, 30.9%; sudden cardiac, 15.2%; other CV, 8%; non-CV, 42.6%).

Among the non-CV deaths, researchers found that 55.1% were caused by sepsis —representing 23.5% of all deaths — with respiratory tract infections accounting for 69.9% of sepsis-related events.

Researchers also found that sepsis death was independently associated with older age (HR = 1.05; 95% CI, 1.03-1.07), greater prevalence of chronic obstructive pulmonary disease (HR = 2.43; 95% CI, 1.74-3.4), male sex (HR = 1.73; 95% CI, 1.16-2.6), lower log serum vitamin D (HR = 0.68; 95% CI, 0.49-0.95) and higher platelet count (HR = 1.0002; 95% CI, 1-1.005) than nonsepsis death.

Furthermore, the variables most associated with sepsis death demonstrated a different profile than other non-CV death, progressive HF, sudden cardiac death and all-cause death, with low serum vitamin D showing a unique association with sepsis death, according to the researchers.

Finally, researchers observed that sepsis death was more likely to occur in a hospital setting than other deaths (86.1% vs. 49.4%; P < .001).

“Our analysis of a large well-characterized cohort with [chronic] HF and reduced LVEF shows that sepsis accounts for almost a quarter of deaths, making this the second most common mode of death after progressive heart failure,” the researchers wrote. “[These results] may have major implications for strategies to further improve the outcomes of people with [chronic] HF and poses important questions about whether sepsis can be prevented or mitigated to improve net survival. More broadly, our analyses highlight the heterogenous mortality of people with [chronic] HF, further emphasizing that more nuanced risk stratification and intervention may offer a more effective approach to improve overall survival.” – by Melissa J. Webb

Disclosures: Walker reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

 

Sepsis is a leading cause of death in people with chronic HF with reduced left ventricular ejection fraction and may be preventable, according to a study published in the Journal of the American Heart Association.

“A key finding of our study is the distinct contribution of baseline patient characteristics to the prediction of sepsis, other noncardiovascular, progressive heart failure and sudden cardiac death,” Andrew M. N. Walker, MBChB, PhD, of the Leeds Institute of Cardiovascular and Metabolic Medicine at the University of Leeds, U.K., and colleagues wrote. “This implies that sepsis is a distinct mode of death and not simply a misclassification of other modes of death. Perhaps more importantly, by showing unique/specific risk markers for each mode of death, our observations suggest that more nuanced risk prediction could guide targeted interventions to improve survival.”

To investigate the prevalence of death from sepsis in patients with chronic HFrEF and to determine its risk marker profile, researchers conducted a prospective cohort study of 1,802 patients with chronic HF and LVEF of 45% or less who attended specialist cardiology clinics in four U.K. hospitals between 2006 and 2014.

Modes of death were categorized as sudden cardiac, progressive HF, other CV death or non-CV death. There was a final censorship date of May 8, 2016.

Patients were followed up during a 10.3-year period (mean, 4 years), during which 737 deaths occurred (progressive HF, 30.9%; sudden cardiac, 15.2%; other CV, 8%; non-CV, 42.6%).

Among the non-CV deaths, researchers found that 55.1% were caused by sepsis —representing 23.5% of all deaths — with respiratory tract infections accounting for 69.9% of sepsis-related events.

Researchers also found that sepsis death was independently associated with older age (HR = 1.05; 95% CI, 1.03-1.07), greater prevalence of chronic obstructive pulmonary disease (HR = 2.43; 95% CI, 1.74-3.4), male sex (HR = 1.73; 95% CI, 1.16-2.6), lower log serum vitamin D (HR = 0.68; 95% CI, 0.49-0.95) and higher platelet count (HR = 1.0002; 95% CI, 1-1.005) than nonsepsis death.

Furthermore, the variables most associated with sepsis death demonstrated a different profile than other non-CV death, progressive HF, sudden cardiac death and all-cause death, with low serum vitamin D showing a unique association with sepsis death, according to the researchers.

Finally, researchers observed that sepsis death was more likely to occur in a hospital setting than other deaths (86.1% vs. 49.4%; P < .001).

“Our analysis of a large well-characterized cohort with [chronic] HF and reduced LVEF shows that sepsis accounts for almost a quarter of deaths, making this the second most common mode of death after progressive heart failure,” the researchers wrote. “[These results] may have major implications for strategies to further improve the outcomes of people with [chronic] HF and poses important questions about whether sepsis can be prevented or mitigated to improve net survival. More broadly, our analyses highlight the heterogenous mortality of people with [chronic] HF, further emphasizing that more nuanced risk stratification and intervention may offer a more effective approach to improve overall survival.” – by Melissa J. Webb

Disclosures: Walker reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.