To evaluate the impact of pneumonia on outcomes of decompensated chronic heart failure (CHF) in patients with liver cirrhosis and chronic kidney disease (CKD) of different severity.
Material and methods
We analyzed the database of ‘ORAKUL-RF’ registry that included males and females with decompensated CHF and volume overload who were admitted in 2010-2013 to 41 Russian clinics in 20 cities. At 30, 90, 180 and 360 days after discharge from the hospital we studied the rate of readmissions and mortality in patients with 4 clinical phenotypes: (1) mild pneumonia + CKD 3 to 4 stage + CHF Forrester class B or C; (2) CKD 3 to 4 stage + CHF Forrester class B or C; (3) mild pneumonia + liver cirrhosis Child Pugh class B or C + CHF Forrester class B or C; (4) liver cirrhosis Child-Pugh class B + CHF Forrester class B or C.
Mortality was high in patients with all four clinical phenotypes. CKD 1 to 2 stage had no impact on mortality in patients with decompensated CHF while even mild pneumonia significantly increased a risk of death after day 30 of followup. Mortality in patients with cirrhosis Child-Pugh class B was higher than in patients with Child-Pugh class A after day 30 of follow-up. Pneumonia in patients with Child-Pugh class A cirrhosis was associated with higher risk of death though the differences did not reach statistical significancy due to low number of patients with cirrhosis and pneumonia. Development of pneumonia in patients with Child-Pugh class B cirrhosis and decompensated CHF Forrester class B or C signicantly increased a risk of death (OR 1.82).
Clinical phenotypes may be used to predict mortality in decompensated CHF patients.
Pneumonia, chronic heart failure, CKD, liver cirrhosis, mortality.