{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T12:12:48Z","timestamp":1780402368968,"version":"3.54.1"},"reference-count":28,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T00:00:00Z","timestamp":1780185600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Sepsis-associated cardiac dysfunction has historically been characterized as predominantly systolic, yet the burden of heart failure with the preserved ejection fraction (HFpEF) phenotype among patients with heart failure (HF) first documented during sepsis remains poorly defined. Methods: In a single-center retrospective cohort of adults (\u226518 years) admitted to a tertiary-care hospital between 1 January 2022 and 31 December 2024, we identified patients whose first sepsis diagnosis (ICD-10) coincided with their first HF diagnosis (ICD-10 I50.x) during the same encounter, with no prior HF in the EHR. Patients were classified by ICD-10 subtype as HFpEF, HFrEF, combined, or unspecified; the unspecified group underwent echocardiographic reclassification when LVEF was documented. Demographics, selected comorbidities, peak inflammatory markers, and unadjusted in-hospital and subsequent-encounter outcomes were compared between HFpEF and HFrEF. Results: Of 924 patients with HF first documented during sepsis, 438 (47.4%) were ICD-10\u2013coded HFpEF and 405 (43.8%) HFrEF. HFpEF patients were older (74.0 vs. 69.2 years; p &lt; 0.001) and more often female (53.0% vs. 37.0%; p &lt; 0.001), with higher prevalence of COPD exacerbation (21.5% vs. 13.1%; p = 0.004) and hypothyroidism (26.3% vs. 17.5%; p = 0.034). HFrEF patients exhibited higher peak lactate (2.88 vs. 2.48 mmol\/L; p = 0.009) and procalcitonin (8.52 vs. 7.24 ng\/mL; p = 0.011). Unadjusted in-hospital mortality (28.1% vs. 27.7%; p = 0.95), ICU admission (75.8% vs. 74.8%; p = 0.80), and length of stay did not differ. Subsequent encounters were descriptively more frequent after HFpEF (11.0% vs. 6.2%). Conclusions: ICD-10\u2013coded HFpEF and HFrEF occurred at nearly equal frequency among adults with HF first documented during sepsis, challenging the systolic-centric paradigm. Despite distinct demographic and biochemical profiles, unadjusted in-hospital outcomes did not differ. These descriptive findings, limited by administrative-coding-based phenotype classification, the absence of multivariable adjustment, and unmeasured sepsis-severity and comorbidity variables, are hypothesis-generating and support phenotype-aware prospective study of HF arising during sepsis.<\/jats:p>","DOI":"10.3390\/jcm15114252","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T11:25:31Z","timestamp":1780399531000},"page":"4252","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Phenotypes and Outcomes of Heart Failure First Diagnosed During Sepsis: A Single-Center Retrospective Cohort Study Using ICD-10-Based Subtype Classification"],"prefix":"10.3390","volume":"15","author":[{"given":"Arun Gajan","family":"Pradeep","sequence":"first","affiliation":[{"name":"Department of Medicine, Northwell Health at Staten Island University Hospital, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaineb","family":"Zubair","sequence":"additional","affiliation":[{"name":"Department of Medicine, Northwell Health at Staten Island University Hospital, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8976-0411","authenticated-orcid":false,"given":"Kaiyu","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of Medicine, Northwell Health at Staten Island University Hospital, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad Bahij","family":"Moumneh","sequence":"additional","affiliation":[{"name":"Department of Medicine, Northwell Health at Staten Island University Hospital, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Ennab","sequence":"additional","affiliation":[{"name":"Department of Medicine, Northwell Health at Staten Island University Hospital, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7010-9433","authenticated-orcid":false,"given":"Omar","family":"Khayat","sequence":"additional","affiliation":[{"name":"Department of Medicine, Northwell Health at Staten Island University Hospital, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3399-760X","authenticated-orcid":false,"given":"Ahmed A.","family":"Zayed","sequence":"additional","affiliation":[{"name":"Department of Medicine, Northwell Health at Staten Island University Hospital, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin Miguel I.","family":"Amor","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Northwell Health at Staten Island University Hospital, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, regional, and national sepsis incidence and mortality, 1990\u20132017: Analysis for the Global Burden of Disease Study","volume":"395","author":"Rudd","year":"2020","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1016\/j.mayocp.2012.01.018","article-title":"Clinical spectrum, frequency, and significance of myocardial dysfunction in severe sepsis and septic shock","volume":"87","author":"Pulido","year":"2012","journal-title":"Mayo Clin. Proc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1007\/s00134-015-3748-7","article-title":"Diastolic dysfunction and mortality in septic patients: A systematic review and meta-analysis","volume":"41","author":"Sanfilippo","year":"2015","journal-title":"Intensiv. Care Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1097\/SHK.0000000000000952","article-title":"New-Onset Heart Failure and Mortality in Hospital Survivors of Sepsis-Related Left Ventricular Dysfunction","volume":"49","author":"Vallabhajosyula","year":"2018","journal-title":"Shock"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1097\/CCM.0000000000002851","article-title":"Septic Cardiomyopathy","volume":"46","author":"Beesley","year":"2018","journal-title":"Crit. Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1038\/s41569-020-00492-2","article-title":"Pathophysiology of sepsis-induced cardiomyopathy","volume":"18","author":"Hollenberg","year":"2021","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3339","DOI":"10.1093\/eurheartj\/ehaf340","article-title":"Sepsis-induced cardiomyopathy","volume":"46","author":"Aissaoui","year":"2025","journal-title":"Eur. Hear. J."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Liu, Y.-C., Yu, M.-M., Shou, S.-T., and Chai, Y.-F. (2017). Sepsis-Induced Cardiomyopathy: Mechanisms and Treatments. Front. Immunol., 8.","DOI":"10.3389\/fimmu.2017.01021"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1093\/eurheartj\/ehr351","article-title":"Diastolic dysfunction and mortality in severe sepsis and septic shock","volume":"33","author":"Landesberg","year":"2011","journal-title":"Eur. Heart J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1186\/s13054-015-1014-6","article-title":"Association of left ventricular longitudinal strain with central venous oxygen saturation and serum lactate in patients with early severe sepsis and septic shock","volume":"19","author":"Lanspa","year":"2015","journal-title":"Crit. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e009684","DOI":"10.1161\/JAHA.118.009684","article-title":"Prevalence and Predictors of Sepsis Death in Patients With Chronic Heart Failure and Reduced Left Ventricular Ejection Fraction","volume":"7","author":"Walker","year":"2018","journal-title":"J. Am. Hear. Assoc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"102696","DOI":"10.1016\/j.cpcardiol.2024.102696","article-title":"Sepsis and septic shock outcomes and 90-day readmissions in heart failure with reduced ejection fraction: A national readmission database study","volume":"49","author":"Mohamoud","year":"2024","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.jacc.2013.02.092","article-title":"A novel paradigm for heart failure with preserved ejection fraction: Comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation","volume":"62","author":"Paulus","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1093\/cvr\/cvaa217","article-title":"Metabolic inflammation in heart failure with preserved ejection fraction","volume":"117","author":"Schiattarella","year":"2020","journal-title":"Cardiovasc. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"147","author":"Altman","year":"2007","journal-title":"Ann. Intern. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1001\/jama.2017.13836","article-title":"Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009\u20132014","volume":"318","author":"Rhee","year":"2017","journal-title":"JAMA"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e263","DOI":"10.1016\/j.jacc.2021.12.012","article-title":"2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"79","author":"Heidenreich","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3627","DOI":"10.1093\/eurheartj\/ehad195","article-title":"2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"44","author":"Metra","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_20","first-page":"e306","article-title":"Administrative data have high variation in validity for recording heart failure","volume":"26","author":"Quach","year":"2010","journal-title":"Can. J. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"McCormick, N., Lacaille, D., Bhole, V., and Avina-Zubieta, J.A. (2014). Validity of Heart Failure Diagnoses in Administrative Databases: A Systematic Review and Meta-Analysis. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0104519"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1038\/nrcardio.2017.65","article-title":"Epidemiology of heart failure with preserved ejection fraction","volume":"14","author":"Dunlay","year":"2017","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1161\/CIRCULATIONAHA.106.678359","article-title":"Sepsis and the Heart","volume":"116","author":"Merx","year":"2007","journal-title":"Circulation"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1164\/rccm.201307-1321OC","article-title":"Risk of cardiovascular events in survivors of severe sepsis","volume":"189","author":"Yende","year":"2014","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1161\/CIRCULATIONAHA.119.041886","article-title":"Research Priorities for Heart Failure With Preserved Ejection Fraction: National Heart, Lung, and Blood Institute Working Group Summary","volume":"141","author":"Shah","year":"2020","journal-title":"Circulation"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"V\u00eertosu, D.-M., Dragomir, A.M., Cri\u0219an, S., Luca, S., P\u0103tru, O., B\u0103ghin\u0103, R.-M., Laz\u0103r, M.-A., Cozlac, A.-R., Iurciuc, S., and Luca, C.-T. (2025). Prevalence of Healthcare-Associated Infections in Patients with Cardiovascular Diseases: A Literature Review. J. Clin. Med., 14.","DOI":"10.3390\/jcm14144941"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Chebl, R.B., Berbari, I., Safa, R., Shami, A., Sabra, M., Jamali, S., Makki, M., Tamim, H., and Dagher, G.A. (2020). Clinical Outcome of Septic Patients With Heart Failure With Preserved Ejection Fraction Presenting to the Emergency Department of a Tertiary Hospital: A Retrospective Cohort Study. Front. Med., 7.","DOI":"10.3389\/fmed.2020.517999"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1038\/s41598-024-83443-y","article-title":"Association of pre-exiting heart failure with long-term mortality and the recurrence of sepsis","volume":"15","author":"Zhu","year":"2025","journal-title":"Sci. Rep."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4252\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T11:50:29Z","timestamp":1780401029000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4252"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,31]]},"references-count":28,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15114252"],"URL":"https:\/\/doi.org\/10.3390\/jcm15114252","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,31]]}}}