INTRODUCTION

The development of pneumonia after cardiac surgery is a significant postoperative complication that may lead to worse clinical outcomes. We aimed to identify risk factors associated with it and determine its clinical impact in terms of in-hospital mortality and morbidity.

METHODS

This was a cross-sectional study among all adult patients who underwent cardiac surgery from 2014 to 2019 in a tertiary hospital in the Philippines. Baseline characteristics and risk factors for pneumonia were retrieved from medical records. Nosocomial pneumonia was based on the Centers for Disease Control and Prevention criteria. Odds ratios from logistic regression were computed to determine risk factors and clinical outcomes for pneumonia using STATA 15.0 (StataCorp, College Station, Texas).

RESULTS

Of 373 patients included, 104 (28%) acquired pneumonia. Most surgeries were ere coronary artery bypass grafting (71.58%). Age, sex, body mass index, diabetes, left ventricular/ renal dysfunction, chronic obstructive pulmonary disease/asthma, surgical urgency, surgical time, and smoking did not show association with pneumonia development. However, preoperative stay of >2 days was associated with 92.3% increased odds of having pneumonia (P = 0.009). Also, every additional hour on mechanical ventilation conferred 0.8% greater odds of acquiring pneumonia (P = 0.003). Patients who developed pneumonia had 3.9-times odds of mortality (95% confidence interval [CI], 1.51-9.89; P = 0.005), 3.8-times odds of prolonged hospitalization (95% CI, 1.81-7.90; P <0.001), 6.4-times odds of prolonged intensive care unit stay (95% CI, 3.59-11.35; P 0.001), and 9.5-times odds of postoperative reintubation (95% CI, 3.01-29.76; P <0.001), 6.4-times odds of prolonged intensive care unit stay (95% CI, 3.59–11.35; P <0.001), and 9.5-times odds of postoperative reintubation (95% CI, 3.01–29.76; P <0.001).

CONCLUSION

Among adult patients undergoing cardiac surgeries, prolonged preoperative hospital stay and prolonged mechanical ventilation were associated with an increased risk of nosocomial pneumonia. Those who developed pneumonia had worse outcomes with significantly increased in-hospital mortality, prolonged hospitalization/intensive care unit stay, and increased postoperative reintubation. Clinicians should therefore minimize delays in surgery and encourage timely liberation from mechanical ventilation after surgery.

INTRODUCTION

Respiratory symptoms are the most commonly observed clinical manifestations in patients with COVID-19 infection; however, some patients may present with cardiovascular complications. Patients with underlying cardiovascular diseases are associated with increased mortality risk. This study aimed to provide local data on the clinical profile and cardiovascular outcomes and to determine predictors of in-hospital mortality among COVID-19 patients admitted to a tertiary care hospital in the Philippines.

METHODS

This single-center retrospective study included hospitalized patients diagnosed with COVID-19 between March 2020 and May 2022. Clinical parameters were subjected to univariate and multivariate regression analyses, with in-hospital mortality as the dependent variable.

RESULTS

A total of 1341 patients were admitted with a mean age of 50 years, half of whom were males. Hypertension is the most common comorbidity (728 [54.3%]), followed by diabetes mellitus (393 [29.3%]) and heart disease (136 [10.1%]). Patients admitted to the intensive care unit had significantly higher systolic blood pressure than non–intensive care unit patients (127 ± 19 vs 139 ± 26 mm Hg; P < 0.001), as well as higher plasma erythrocyte sedimentation rate, C-reactive protein, D-dimer, troponin, ferritin, and lactate dehydrogenase. The most common cardiac complications observed were heart failure (39%), acute cardiac injury (30%), and arrhythmia (30%). During hospitalization, 100 patients (7.4%) died; almost half were admitted to the critical care unit, and 84 had cardiac complications, with heart failure (21%) being the most common. Sinus tachycardia was the most common electrocardiographic abnormality (436 [32%]). Univariate analysis showed diabetes (odds ratio [OR], 2.7; P = 0.029) and hypertension (OR, 3.4; P = 0.11). Multivariate analysis revealed that age (OR, 1.095; P < 0.05) and admission duration (OR, 0.906; P < 0.05) were significantly associated with mortality.

CONCLUSION

This study highlights the clinical characteristics of patients contracted with COVID-19 who may experience several cardiac conditions. Therefore, particular attention should be given to the role of preexisting cardiovascular diseases and cardiac complications that may contribute to long-term outcomes. 

Human ; Covid-19 ; Cardiovascular Diseases