[Significance of adipose tissue mass for the clinical course of pneumonia associated with decompensated CHF]

Abstract

Background: Pneumonia is one of most important causes of in-hospital mortality in patients with decompensated chronic heart failure (CHF).

Aim: To evaluate the effect of adipose tissue mass and body weight index (BWI) on prognosis for patients with communityacquired pneumonia and decompensated CHF.

Materials and methods: The study included 286 patients aged 53-90 with BWI 18.5-24.9 kg/m2 who were hospitalized in cardiology and therapy departments of an emergency care hospital for decompensated CHF and pneumonia, which was verified within the first day of admission. Body composition was analyzed using a bioimpedance analyzer of body water sectors (ABC-01, Medass); BWI was calculated for all patients. Sputum samples collected with proper observation of sterility rules were analyzed in a specialized microbiological laboratory. Statistical analysis was performed with methods of binary logistic regression, Kaplan-Meier, Cox regression, and two-step cluster analysis using the IBM SPSS Statistics 20 software.

Results: Assessing the body composition showed that groups with sputum Str. Pneumonia and mixed infection differed in indexes of lean body mass and adipose tissue mass but not in BWI. In-the mixed group, the in-hospital mortality was 38.71% and the one-year mortality - 95.16%. In the group with Str. Pneumonia in the sputum culture, the in-hospital mortality was 18.52% and the one-year mortality - 42.59%. The two-step cluster analysis allowed to isolate two clusters in the structure of the studied totality. All patients of the first cluster died during the first 9 months of the year following hospitalization. They were distinguished by lower values of lean body mass and BWI, older age, and the presence of mixed infection in the sputum culture in 39.1% of cases.

Conclusion: In the structure of the studied totality, the most important risk factor for in-hospital mortality and one-year death was the value of adipose tissue mass.

Keywords: pneumonia, decompensated CHF, mixed infection, body composition, fat mass, bioimpedancemetry, cohort study, comorbidity.