H2FPEF skorunun pnömoni’li hastalardaki prognostik önemi

Year 2025, Volume: 3 Issue: 1, 24 - 28, 01.02.2025

İbrahim Saraç , Alperen Aksakal , Muhammed Cüneyt Şeker , Gizem Çil , Yavuzer Koza

https://doi.org/10.61845/agrimedical.1594189

Abstract

Amaç: H2FPEF skoru, korunmuş ejeksiyon fraksiyonlu kalp yetersizliği (KEFKY) hastalarında tanısal açıdan kullanılan basit ve güvenilir bir araç olup, önemli komorbiditeleri içermektedir. Çalışmamızda pnömoni nedeniyle takip edilen hastaların klinik prognozu ile bu skor arasındaki ilişkiyi araştırmayı amaçladık.
Gereç ve Yöntem: Çalışmamız prospektif olup, hastaların yatış sırasında ve takip süresi boyunca klinik ve laboratuvar verileri dokümante edildi. Hastalar KEFKY olma olasılığına göre H2FPEF skoru kullanılarak gruplara ayrıldı. Bu gruplardaki hastalar mortalite ve yoğun bakım yatışı oranlarına, ek klinik ve laboratuvar parametrelerine göre karşılaştırıldı.
Bulgular: KEFKY olma olasılığı yüksek olan grupta diğer gruplara göre hastaların yaşı ve komorbiditeleri oldukça fazla izlendi (p<0,001). Bu grupta pnömoni ciddiyeti, mortalite oranları ve yoğun bakım yatış oranları diğer gruplara göre istatistiksel olarak anlamlı izlendi(p<0,001). KEFKY olasılığı arttıkça gruplarda pnömoni ciddiyetinin ve klinik prognozun kötüleştiği görüldü.
Sonuç: KEFKY bir komorbiditeler bütünü olup eşlik ettiği hastalıkların prognozunu oldukça olumsuz etkilemektedir. Açıklanamayan dispne ve konjestif kalp yetersizliği (KKY) bulguları varlığında, tedaviye dirençli veya komorbiditelerin eşlik ettiği pnömoni vakalarında KEFKY varlığı akılda tutulmalıdır.

Keywords

Kalp yetersizliği, Korunmuş ejeksiyon fraksiyonu, Prognoz, Pnömoni

The prognostic importance of H2FPEF score in patients with pneumonia

Abstract

Aim: The H2FPEF score is a simple and reliable tool used diagnostically in patients with heart failure with preserved ejection fraction (HFpEF) and includes important comorbidities. In our study, we aimed to investigate the relationship between this score and the clinical prognosis of patients followed for pneumonia.
Material and Method: Our study is prospective and the clinical and laboratory data of the patients were documented during hospitalization and during the follow-up period. Patients were divided into groups using the H2FPEF score according to the probability of having HfpEF. Patients in these groups were compared according to mortality and intensive care hospitalization rates, additional clinical and laboratory parameters.
Results: The age and comorbidities of the patients were observed to be significantly higher in the group with a high probability of having HfpEF compared to the other groups (p<0.001). The severity of pneumonia, mortality rates and intensive care hospitalization rates were statistically significant in this group compared to other groups (p<0.001). As the probability of HfpEF increased, the severity of pneumonia and clinical prognosis worsened in the groups.
Conclusions: The mortality and intensive care hospitalization rates of patients followed up due to pneumonia were monitored in proportion to the high H2FPEF score. HfpEF is a set of comorbidities and has a very negative impact on the prognosis of the diseases it accompanies. In the presence of unexplained signs of dyspnea and congestive heart failure (CHF), the presence of HfpEF should be kept in mind in cases of pneumonia that are resistant to treatment or accompanied by comorbidities. There is a great need for studies that will increase the awareness level of HfpEF.
Keywords: Heart failure, Preserved ejection fraction, Pneumonia, Prognosis

Keywords

Heart failure, Preserved ejection fraction, Pneumonia, Prognosis

References

• 1. Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC Expert Consensus Decision Pathway on Management of Heart Failure With Preserved Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol.2023;81(18):1835-78.
• 2. McDonagh TA, Metra M, Adamo M, et al. ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 42(36):3599-3726.
• 3. Obokata M, Kane GC, Reddy YN, Olson TP, Melenovsky V, Borlaug BA. Role of Diastolic Stress Testing in the Evaluation for Heart Failure With Preserved Ejection Fraction: A simultaneous ınvasive-echocardiographic study. Circulation. 2017;135(9):825-38.
• 4. Reddy YNV, Carter RE, Obokata M, Redfield MM, Borlaug BA. A simple, evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction. Circulation. 2018;138(9):861-70.
• 5. Pieske B, Tschöpe C, de Boer RA, et al. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J. 2019 ;40(40):3297-3317.
• 6. Paulus WJ. H₂FPEF Score: At Last, a Properly validated diagnostic algorithm for heart failure with preserved ejection fraction. Circulation. 2018;138(9):871-3.
• 7. Patel P, Ruge M, Gomez JMD, et al. Prognostic value of H₂FPEF score in COVID-19. Am Heart J Plus. 2022;13:100111.
• 8. Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29(4):277-314.
• 9. Musher DM, Thorner AR. Community-acquired pneumonia. N Engl J Med. 2014;371(17):1619-28.
• 10. GBD 2015 LRI Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis. 2017;17(11):1133-61.
• 11. Lutfiyya MN, Henley E, Chang LF, Reyburn SW. Diagnosis and treatment of communityacquired pneumonia. Am Fam Physician. 2006;73(3):442-50.
• 12. File TM. Community-acquired pneumonia. Lancet. 2003;362(9400):1991-2001.
• 13. Ramirez JA, File TM. How to assess survival prognosis in patients hospitalized for communityacquired pneumonia in 2024? Curr Opin Crit Care. 2024;30(5):399-405.
• 14. Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997 ;336(4):243-50.
• 15. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 ;44 Suppl 2(Suppl 2):S27-72.
• 16. Bader F, Manla Y, Atallah B, Starling RC. Heart failure and COVID-19. Heart Fail Rev. 2021;26(1):1-10.
• 17. Sueta D, Yamamoto E, Nishihara T, et al. H₂FPEF Score as a prognostic value in HFpEF patients. Am J Hypertens. 2019 ;32(11):1082-90.
• 18. Redfield MM. Heart failure with preserved ejection fraction. N Engl J Med. 2016 ;375(19):1868- 77.
• 19. LaForce FM, Mullane JF, Boehme RF, Kelly WJ, Huber GL. The effect of pulmonary edema o antibacterial defenses of the lung. J Lab Clin Med. 1973;82(4):634-48.
• 20. Jain S, Self WH, Wunderink RG, et al. Community-Acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015;373(5):415-27.
• 21. Montull B, Menéndez R, Torres A, et al. Predictors of severe sepsis among patients hospitalized for community-acquired pneumonia. PLoS One. 2016;11(1):e0145929.
• 22. Sinapidis D, Kosmas V, Vittoros V, et al. Progression into sepsis: an individualized process varying by the interaction of comorbidities with the underlying infection. BMC Infect Dis. 2018;18(1):242.
• 23. Shen L, Jhund PS, Anand IS, et al. Incidence and outcomes of pneumonia in patients with heart failure. J Am Coll Cardiol. 2021;77(16):1961-73.
• 24. Corrales-Medina VF, Alvarez KN, Weissfeld LA, et al. Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease. JAMA. 2015 Jan 20;313(3):264-74.
• 25. Ekin T, Kış M, Güngören F, et al. Awareness and knowledge of pneumococcal vaccination in cardiology outpatient clinics and the ımpact of physicians' recommendations on vaccination rates. Vaccines (Basel). 2023;11(4):772.