Misdiagnosis of Sepsis in Patients with Acutely Decompensated Heart Failure. Real World Outcomes

Introduction Acutely decompensated heart failure (ADHF) is a complex clinical syndrome that has a heterogeneous presentation often mimicked by multiple conditions, including sepsis. There is limited data on the prevalence and factors associated with sepsis misdiagnoses in patients experiencing ADHF. Methods This is a retrospective cohort study of patients admitted to tertiary cardiovascular center with a primary diagnosis of sepsis and heart failure (chronic or newly diagnosed) between January 2015 and December 2018. Primary outcomes include the prevalence of sepsis misdiagnosis in patients with ADHF. Secondary outcomes include analysis of factors associated with sepsis misdiagnoses in patients with ADHF. Results A total of 974 patients with a diagnosis of sepsis and a history of heart failure (HF) or newly diagnosed HF admitted to our institution between January 2015, and December 2018 were included in the study. Out of the 974 patients, 536 were male with a mean age of 75±14. Sepsis was misdiagnosed in 246/974 patients with ADHF. Current clinical and laboratory criteria used to diagnose sepsis and classify its severity (i.e., tachycardia, tachypnea, leukocytosis, organ dysfunction [i.e., elevated BUN, creatinine, lactic acidosis]) were significantly abnormal in both groups (Sepsis and no-sepsis [ADHF] patients. See table for baseline characteristics. All patients (974) received early sepsis-goal directed therapy including intravenous fluid administration. Conclusions This study suggests that standard clinical and laboratory criteria use to diagnose and classified sepsis are present in patients with ADHF. Sepsis can be misdiagnosed in up to 25% of the patients with ADHF, carrying a significant treatment consequence such as aggressive fluid administration. Further studies are recommended to test this hypothesis.