Secondary analysis of potential associations between oral health and infection-related parameters in patients with severe heart failure-results of a German cohort

Gerhard Schmalz; Alina Hennecke; Rainer Haak; Tanja Kottmann; Jens Garbade; Christian Binner; Dirk Ziebolz

doi:10.1186/s12872-023-03612-1

Secondary analysis of potential associations between oral health and infection-related parameters in patients with severe heart failure-results of a German cohort

BMC Cardiovasc Disord. 2023 Nov 21;23(1):573. doi: 10.1186/s12872-023-03612-1.

Authors

Gerhard Schmalz^#¹, Alina Hennecke^#², Rainer Haak², Tanja Kottmann³, Jens Garbade⁴, Christian Binner^#⁵, Dirk Ziebolz^#²

Affiliations

¹ Department of Cariology, Endodontology and Periodontology, University Leipzig, Liebigstr. 12, D 04103, Leipzig, Germany. gerhard.schmalz@medizin.uni-leipzig.de.
² Department of Cariology, Endodontology and Periodontology, University Leipzig, Liebigstr. 12, D 04103, Leipzig, Germany.
³ CRO Dr. med. Kottmann GmbH & Co. KG, Hamm, Germany.
⁴ Department of Cardiac Surgery, Klinikum Links der Weser, 28277, Bremen, Germany.
⁵ University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.

^# Contributed equally.

Abstract

Objectives: Aim of this retrospective cohort study was to evaluate whether oral health parameters would be associated with infection-related parameters and overall survival of patients with severe heart failure (HF).

Methods: Patients with severe HF, heart transplantation (HTx) and left-ventricular assist device (LVAD), which underwent a full oral examination between 2017 and 2018 were included. Infection-related and survival data were assessed from the patient´s medical records. The oral examination included: remaining teeth, caries and periodontal condition, including periodontal probing depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), and diagnosis (staging/grading). In addition, the periodontal inflamed surface area (PISA) was determined. Statistical analysis included Chi-square, Fisher´s exact and Mann-Whitney-U test, as well as a logistic regression, considering age, gender, body-mass-index (BMI), diabetes and several oral health parameters with regard to overall survival and infections at heart/driveline.

Results: 329 patients (HTx: 34%, LVAD: 38.9%, HF: 27.1%), were included. Patients had on average 18.96 ± 8.90 remaining teeth, whereby the majority had a periodontitis stage III or IV (88.7%) and a grade B (80.5%). Higher BOP was associated with infections at heart/driveline (p = 0.04) and outside the heart (p < 0.01) during follow-up. Increased PISA was significantly associated with bacterial infections outside the heart (p < 0.01) and sepsis (p = 0.02). Only BMI of 25 or higher correlated with an increased risk of infections at heart/driveline in regression analysis (OR 3.063, CI₉₅ 1.158-8.101, p = 0.02), while no associations between oral health parameters and infections at heart/driveline or overall survival were confirmed.

Conclusions: In patients with severe HF, periodontal inflammation might be associated with infection-related parameters. Improved dental care, especially including periodontal therapy and maintenance might be favourable to support prevention of infections in patients with severe HF.

Keywords: Heart Failure; Infection; Oral health; Periodontal medicine; Periodontitis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Heart Failure* / diagnosis
Heart Failure* / epidemiology
Heart Failure* / therapy
Humans
Oral Health
Periodontal Diseases*
Periodontitis* / diagnosis
Periodontitis* / epidemiology
Periodontitis* / therapy
Retrospective Studies