Factors Associated with Intra-hospital Mortality of Peripartum Cardiomyopathy Patients in Northcentral Nigeria
Ogunmodede James Ayodele *
Department of Medicine, University of Ilorin, Ilorin, Kwara State, Nigeria.
Kolo Philip Manma
Department of Medicine, University of Ilorin, Ilorin, Kwara State, Nigeria.
Dele-Ojo Bolade Folashade
Department of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria.
Ogunmodede Adebusola Jane
Department of Behavioural Sciences, University of Ilorin Teaching Hospital, Ilorin, Kwara state, Nigeria.
Yusuf Idris Abiola
Dalhatu Araf Specialist Hospital, Lafia, Nassarawa State, Nigeria.
Katibi Ibraheem Adeola
Department of Medicine, University of Ilorin, Ilorin, Kwara State, Nigeria.
Omotoso Ayodele Babatunde
Department of Medicine, University of Ilorin, Ilorin, Kwara State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Aims: We studied the patient characteristics, intra-hospital outcomes and factors associated with intra-hospital mortality in patients admitted for Peripartum Cardiomyopathy (PPCM) in our centre using data from the Ilorin Heart failure Registry.
Study design: Prospective Observational
Methodology: All the 22 confirmed PPCM patients admitted between January 1, 2016 and December 31, 2019 were recruited and followed up for intra-hospital outcomes. The primary outcome was all-cause intra-hospital mortality.
Results: Intra-hospital death occurred in four out of 22 patients (18.2%). The mean age of all patients was 28.4 ± 4.8 years and it was similar in both survivors and patients who died (P=0.960). Majority of patients (14, 63.7%) presented in New York Heart Association Class IV. Mean duration of hospital stay was 11 + 5.7days which was similar between patients who died and those who survived hospital admission (9.0 ± 2.8 vs 11.4 ± 6.1, P=0.457). Median ECG heart rate was 120 (116-123) bpm which was similar between both groups. Factors associated with mortality were biochem ical parameters serum sodium and eGFR which were significantly lower among those who died (125.0 ± 4.1 vs 133.7 ± 2.5mmol/L, P=<0.001; 41.0 ± 18.8 vs 81.9 ± 11.03 mls/min/1.73m2, P<0.001) and the Ejection fraction (EF) and Fractional Shortening (FS) which were also significantly lower in the patients who died 24.0 ± 8.2% vs 37.9 ± 6.2%, P=0.002; 11.0 ± 4.3% vs 18.4 ± 3.8, P=0.003 respectively. Other echocardiographic parameters were similar between the two groups of patients. A Kaplan-Meier survival curve was drawn to show the time to outcome.
Conclusion: Majority of PPCM patients present in clinically severe heart failure and the intra-hospital mortality is high. The importance of serum sodium, eGFR, EF and FS as factors associated with mortality indicates patient sub-groups requiring greater attention and targeted interventions.
Keywords: Peripartum cardiomyopathy, Northcentral Nigeria, intra-hospital mortality, Ilorin heart failure registry