P-2157. Comparative Analysis of Sepsis Outcomes in Patients with Left Ventricular Assist Devices versus Heart Transplantation: A National Database Analysis

TL;DR

This study compares sepsis outcomes in patients with heart transplants and LVADs, finding higher mortality and costs in both groups compared to standard heart failure patients.

Contribution

The study provides the first national analysis of sepsis incidence, etiology, and outcomes in LVAD and heart transplant patients compared to medically managed heart failure patients.

Findings

LVAD patients had higher in-hospital mortality (23.4%) compared to heart transplant (21.2%) and heart failure (19.5%) patients.

Heart transplant recipients had longer hospital stays (89.8 days) and higher costs ($2.85M) compared to other groups.

LVAD patients had higher rates of device-related infections and Pseudomonal sepsis, while transplant recipients had higher Candidal sepsis rates.

Abstract

Heart transplantation and Left Ventricular Assist Devices (LVAD) are treatment options for end-stage heart failure. Infectious complications are common among both groups, however there is a paucity of data evaluating the burden of sepsis in these cohorts. This study aims to compare the incidence, epidemiology and outcomes of inpatient admissions for sepsis in patients with LVADs versus heart transplant.Table 1:Demographics and Characteristics of patients with Sepsis; LVAD: left ventricular assist deviceTable 2Etiology of Sepsis in comparator groups; LVAD: left ventricular assist device

Demographics and Characteristics of patients with Sepsis; LVAD: left ventricular assist device

Etiology of Sepsis in comparator groups; LVAD: left ventricular assist device

The National Inpatient Sample (NIS) was queried for inpatient admissions with a primary diagnosis of sepsis or severe sepsis between January 2021 to December 2022. Patients with an LVAD or history of heart transplantation were identified using ICD-10 procedure and diagnosis codes. Patients with heart failure without a history of LVAD implantation or heart transplant served as the control group. Demographics, outcomes, in-hospital mortality, length of stay, disposition, and total hospitalization costs were analyzed using SPSS (v. 30, IBM). Weights assigned in NIS were used to calculate national estimates.

A total of 1,541,024 sepsis admissions were analyzed, including 4,595 LVAD and 1,015 heart transplant recipients (Table 1). Heart transplant recipients were younger (mean 44.5 vs. 58.9 [LVAD] vs. 71.0 years [HF], p< 0.001). LVAD patients had the highest in-hospital mortality (23.4% vs. 21.2% [transplant] vs. 19.5% [HF], p< 0.001). Transplant patients had longer hospital stays (mean 89.8 vs. 30.9 vs. 13.7 days) and higher adjusted costs ($2.85M vs. $828K vs. $197K; p< 0.001). Severe sepsis was more frequent in HF patients (18.3%), while septic shock (46.3%) and bacteremia (3.0%) were more common in transplant recipients (p< 0.001) (Table 2). LVAD patients had higher rates of device-related infections (26.0%) and Pseudomonal sepsis (8.1%), whereas transplant recipients had higher rate of Candidal sepsis (4.4%) (p< 0.001).

LVAD and heart transplant recipients experienced significantly higher mortality, longer hospital stays, and higher inpatient costs compared to medically managed heart failure patients. Given their unique infectious risks—device-related in LVADs and immunosuppression-related in transplant recipients—clinicians must adopt vigilant, cohort-specific strategies to mitigate the infection risks in these populations.

All Authors: No reported disclosures

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