Clinical outcomes of sepsis with and without acute right heart failure: a national inpatient sample study

SESSION TITLE: Sepsis: Novel Identification and Treatment SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Right ventricular dysfunction in sepsis occurs due to decreased myocardial function (contractility and active relaxation) and perfusion and increased pulmonary vascular resistance, and can progress to acute right heart failure (RHF) when the right ventricle (RV) can no longer compensate for increased RV end-diastolic volume. Data regarding the clinical outcomes of sepsis among hospitalizations with and without acute RHF is limited. METHODS: We identified hospitalizations with the primary diagnosis of sepsis in the National Inpatient Sample for 2016-2019 using the International Classification of Diseases - 10th revision (ICD-10) codes. We then identified those that developed acute RHF. We performed a propensity score matching to compare clinical outcomes and resource utilization between sepsis hospitalizations complicated by development of acute RHF compared to controls. The matching process adjusted for demographic factors as well as relevant comorbidities. Second, we also stratified hospitalizations based on the source of sepsis and used multivariate logistic regression to calculate the odds of developing acute RHF. RESULTS: We identified a total of 3,085,490 hospitalizations for sepsis. Following matching, we analyzed a total of 6,760 hospitalizations of which 2,355 developed RHF. RHF was associated with increased odds of mortality (OR 1.63 [1.46 to 1.82]), as well as increased odds for vasopressor need (OR 2.96 [2.54-3.44]), mechanical ventilation (OR 1.75 [1.58-1.93]), new hemodialysis (OR 2.75 [2.20-3.43]) and composite cardiovascular outcomes including acute myocardial infarction, supraventricular arrhythmia and ventricular arrhythmia (OR 1.72 [1.55-1.91]). There were also higher odds of RHF with bacterial pneumonia (OR 1.49 [1.34-1.64]) and skin and subcutaneous tissue infections (OR 1.83 [1.56-2.14]) compared to urinary tract infections (OR 0.68 [0.60-0.77]) and other intra-abdominal infections (OR 0.53 [0.44-0.63]). Sepsis hospitalizations complicated by RHF had greater resource utilization, with longer length of stay (12.1 vs 11.4 days, p<0.05) and increased cost in USD ($45,515.1 vs $35371.9, p<0.05), compared with sepsis hospitalizations without RHF. CONCLUSIONS: Development of acute RHF among sepsis hospitalizations is associated with increased in-hospital mortality and composite cardiovascular outcomes and increased need for vasopressors, mechanical ventilation and new hemodialysis. CLINICAL IMPLICATIONS: More work needs to be done in validating these results and establishing the implications of developing acute RHF in sepsis. In addition, further studies are needed to investigate the treatment and support options for RHF in patients with sepsis. DISCLOSURES: No relevant relationships by Ali Abdelhay No relevant relationships by Omar Al Ali No relevant relationships by Hemanth Krishna Boppana No relevant relationships by Ming-Yan Chow No relevant relationships by Ahmed Elkhapery No relevant relationships by Charoo Iyer No relevant relationships by Chengu Niu