Phenotypes and Outcomes of Heart Failure First Diagnosed During Sepsis: A Single-Center Retrospective Cohort Study...

Area of Science:

• Cardiology
• Critical Care Medicine
• Epidemiology

Background:

• Sepsis-associated cardiac dysfunction is often viewed as primarily systolic.
• The prevalence and characteristics of heart failure with preserved ejection fraction (HFpEF) in patients whose first heart failure (HF) diagnosis occurs during sepsis are not well understood.
• Understanding HF phenotypes during sepsis is crucial for accurate diagnosis and treatment.

Purpose of the Study:

• To determine the frequency of HFpEF versus heart failure with reduced ejection fraction (HFrEF) among patients experiencing their first HF diagnosis during sepsis.
• To compare demographic, comorbidity, and inflammatory profiles between HFpEF and HFrEF groups.
• To compare unadjusted in-hospital outcomes between HFpEF and HFrEF in this population.

Main Methods:

• Retrospective cohort study of adult patients admitted between January 1, 2022, and December 31, 2024.
• Identified patients with a first-time sepsis diagnosis coinciding with a first-time HF diagnosis (ICD-10 I50.x) without prior HF history.
• Classified HF phenotypes (HFpEF, HFrEF) using ICD-10 codes, with echocardiographic reclassification for unspecified cases; compared demographics, comorbidities, inflammatory markers, and outcomes.

Main Results:

• Of 924 patients with HF first diagnosed during sepsis, 47.4% were classified as HFpEF and 43.8% as HFrEF.
• HFpEF patients were older and more frequently female, with higher rates of COPD exacerbation and hypothyroidism.
• HFrEF patients showed higher peak lactate and procalcitonin levels; however, unadjusted in-hospital mortality, ICU admission, and length of stay did not differ significantly between groups.

Conclusions:

• The occurrence of HFpEF and HFrEF is nearly equal among patients with HF first documented during sepsis, challenging the traditional systolic-centric view.
• Distinct demographic and biochemical profiles exist between HFpEF and HFrEF in sepsis, yet in-hospital outcomes were comparable in unadjusted analyses.
• These findings are hypothesis-generating, supporting the need for phenotype-aware prospective studies on sepsis-related HF.