Association between stasis dermatitis and length of stay in heart failure hospitalizations

Background: Stasis dermatitis (SD) is caused by venous hypertension that can be associated with peripheral congestion due to heart failure (HF). Length of stay (LOS) is the primary driver of HF hospitalization costs. Therefore, it is important to determine those patients who will have longer LOS. We aimed to investigate the relationship between the SD and LOS in HF patients. Methods: A total of 308 patients, who were hospitalized between January 2012 and January 2014 due to acute decompensated HF (ADHF) in our center, were evaluated in this retrospective observational cohort study. Patients' baseline clinical characteristics and presence of SD diagnosis within the past 3 months prior the HF hospitalization were assessed by a review of cardiology and dermatology clinics medical records. Results: A total of 237, acutely decompensated, HF patients were enrolled in the study. The median LOS was 5 days, and the mean LOS was 5.4 ± 2 days. Prolonged LOS was defined as LOS >5 days, and the patients were classified into two groups: Those with LOS ≤5 days (Group I) and those with LOS >5 days (Group II, longer LOS). The presence of SD diagnosis was higher in Group II compared to patients in Group I (22% vs. 46%, P < 0.001). In the multivariate logistic regression model, presence of SD diagnosis, presence of moderate-to-severe tricuspid regurgitation, presence of atrial fibrillation, left atrial diameter, creatinine level, sodium level remained associated with longer LOS after adjustment for age, gender and for the variables found to be statistically significant in univariate analysis and correlated with LOS. Conclusions: This was the first time in the literature that a study demonstrated that the presence of SD was associated with an increased the risk of prolonged hospitalization independent of other factors in patients with reduced ejection fraction heart failure admitted for ADHF.