Risk factors of acquired pulmonary infection and death during the first hospitalization after heart transplantation

Yuan Ting; Qiu Beili; Li Yanjun; Zeng Zhu; Xu Fen

doi:10.3760/j.issn.1673-4777.2020.01.011

Abstract：Objective To analyze the risk factors of acquired pulmonary infection and death during the first hospitalization after heart transplantation.Methods A retrospective analysis was made on 520 patients who had heart transplantation in Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from April 2013 to January 2018.General data and clinical characteristics of hospital-acquired pulmonary infection were recorded.Risk factors of pulmonary infection and death were analyzed by single-factor and multi-factor logistic regression.Results Among 520 patients,hospital-acquired pulmonary infection occurred in 66 cases (pulmonary infection group) and 454 patients were induded in non-infection group.Single-factor analysis showed that pulmonary infection group had higher rates of Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score ＞ 6 in 24-48 h after surgery,tracheal intubation ＞ 24 h,re-intubation,indwelling gastric tube ＞ 24 h and postoperative central nervous system complications,as compared with non-infection group [90.9％ (60/66) vs 53.1％ (241/454),77.3％(51/66) vs 33.9％ (154/454),22.7％ (15/66) vs 5.9％ (27/454),40.9％ (27/66) vs 18.1％ (82/454),18.2％ (12/66) vs 4.0％ (18/454)] (all P ＜ 0.05).Logistic regression analysis showed that APACHE Ⅱ score ＞ 6 in 24-48 h after surgery and tracheal intubation ＞ 24 h were independent risk factors of hospital-acquired pulmonary infection(both P ＜ 0.05).Ventilator-associated pneumonia(VAP),fungal infection,the number of pathogenic bacteria species and clinical lung infection score were involved in the analysis of death factors,showing that VAP and the number of pathogenic bacteria species were independent risk factors of death due to pulmonary infection(both P ＜ 0.05).Conclusions APACHE Ⅱ score ＞ 6 in 24-48 h after heart transplantation and tracheal intubation ＞ 24 h are independent risk factors of hospital-acquired pulmonary infection.VAP and the number of pathogen species are risk factors of death caused by pulmonary infection.Effective intervention measures to prevent VAP is important in reducing mortality and improving prognosis.