Acute cardiovascular events in patients with community acquired pneumonia: results from the observational prospective FADOI-ICECAP study.

Aged Aged, 80 and over Community-Acquired Infections Female Hospital Units Hospitalization Humans Incidence Italy / epidemiology Length of Stay Male Middle Aged Myocardial Infarction / complications Pneumonia, Bacterial Prevalence Prospective Studies Risk Factors

Cardiovascular events Community-acquired pneumonia

Journal

BMC infectious diseases

ISSN: 1471-2334

Titre abrégé: BMC Infect Dis

Pays: England

ID NLM: 100968551

Informations de publication

Date de publication:
25 Jan 2021

Historique:

received: 11 06 2020

accepted: 11 01 2021

entrez: 26 1 2021

pubmed: 27 1 2021

medline: 29 1 2021

Statut: epublish

Résumé

The burden of cardiovascular (CV) complications in patients hospitalised for community-acquired pneumonia (CAP) is still uncertain. Available studies used different designs and different criteria to define CV complications. We assessed the cumulative incidence of acute of CV complications during hospitalisation for CAP in Internal Medicine Units (IMUs). This was a prospective study carried out in 26 IMUs, enrolling patients consecutively hospitalised for CAP. Defined CV complications were: newly diagnosed heart failure, acute coronary syndrome, new onset of supraventricular or ventricular arrhythmias, new onset hemorrhagic or ischemic stroke or transient ischemic attack. Outcome measures were: in-hospital and 30-day mortality, length of hospital stay and rate of 30-day re-hospitalisation. A total of 1266 patients were enrolled, of these 23.8% experienced at least a CV event, the majority (15.5%) represented by newly diagnosed decompensated heart failure, and 75% occurring within 3 days. Female gender, a history of CV disease, and more severe pneumonia were predictors of CV events. In-hospital (12.2% vs 4.7%, p < 0.0001) and 30-day (16.3% vs 8.9%, p = 0.0001) mortality was higher in patients with CV events, as well as the re-hospitalisation rate (13.3% vs 9.3%, p = 0.002), and mean hospital stay was 11.4 ± 6.9 vs 9.5 ± 5.6 days (p < 0.0001). The occurrence of CV events during hospitalisation significantly increased the risk of 30-day mortality (HR 1.69, 95% CI 1.14-2.51; p = 0.009). Cardiovascular events are frequent in CAP, and their occurrence adversely affects outcome. A strict monitoring might be useful to intercept in-hospital CV complications for those patients with higher risk profile. NCT03798457 Registered 10 January 2019 - Retrospectively registered.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

This was a prospective study carried out in 26 IMUs, enrolling patients consecutively hospitalised for CAP. Defined CV complications were: newly diagnosed heart failure, acute coronary syndrome, new onset of supraventricular or ventricular arrhythmias, new onset hemorrhagic or ischemic stroke or transient ischemic attack. Outcome measures were: in-hospital and 30-day mortality, length of hospital stay and rate of 30-day re-hospitalisation.

RESULTS RESULTS

A total of 1266 patients were enrolled, of these 23.8% experienced at least a CV event, the majority (15.5%) represented by newly diagnosed decompensated heart failure, and 75% occurring within 3 days. Female gender, a history of CV disease, and more severe pneumonia were predictors of CV events. In-hospital (12.2% vs 4.7%, p < 0.0001) and 30-day (16.3% vs 8.9%, p = 0.0001) mortality was higher in patients with CV events, as well as the re-hospitalisation rate (13.3% vs 9.3%, p = 0.002), and mean hospital stay was 11.4 ± 6.9 vs 9.5 ± 5.6 days (p < 0.0001). The occurrence of CV events during hospitalisation significantly increased the risk of 30-day mortality (HR 1.69, 95% CI 1.14-2.51; p = 0.009).

CONCLUSION CONCLUSIONS

Cardiovascular events are frequent in CAP, and their occurrence adversely affects outcome. A strict monitoring might be useful to intercept in-hospital CV complications for those patients with higher risk profile.

TRIAL REGISTRATION BACKGROUND

NCT03798457 Registered 10 January 2019 - Retrospectively registered.

Identifiants

DOI: 10.1186/s12879-021-05781-w PMID: 33494707 PMC: PMC7830042

pubmed: 33494707

doi: 10.1186/s12879-021-05781-w

pii: 10.1186/s12879-021-05781-w

pmc: PMC7830042

doi:

Banques de données

ClinicalTrials.gov

['NCT03798457']

Types de publication

Journal Article Multicenter Study Observational Study

Langues

eng

Sous-ensembles de citation

Pagination

116

Investigateurs

T Attardo (T)

G Augello (G)

F Dentali (F)

L Tavecchia (L)

V Gessi (V)

F Pieralli (F)

G De Marzi (G)

A Torrigiani (A)

L Corbo (L)

G Uomo (G)

F Gallucci (F)

C Mastrobuoni (C)

F Risaliti (F)

A Giani (A)

L Morbidoni (L)

Consalvo Teodora (C)

A Mazzone (A)

E Ricchiuti (E)

C Santini (C)

A Rosato (A)

D Tirotta (D)

L Giampaolo (L)

F Corradi (F)

A Torrigiani (A)

S Di Gregorio (S)

R Gerloni (R)

L Parodi (L)

P Gnerre (P)

V Vannucchi (V)

F Pallini (F)

G Landini (G)

P Giuri (P)

G Prampolini (G)

D Arioli (D)

M C Leone (MC)

C Canale (C)

F Condemi (F)

R Lupica (R)

F Manzola (F)

R Mascianà (R)

G Agnelli (G)

C Becattini (C)

E D'Agostini (E)

M G Mosconi (MG)

G Bogliari (G)

A Rossi (A)

M Campanini (M)

G Iannantuoni (G)

L Bartolino (L)

A Montagnani (A)

V Verdiani (V)

M Gambacorta (M)

S Lenti (S)

S Francioni (S)

M Giorgi-Pierfranceschi (M)

C Cattabiani (C)

F Orlandini (F)

L Scuotri (L)

M La Regina (M)

F Corsini (F)

L Anastasio (L)

N Mumoli (N)

V Mazzi (V)

A Camaiti (A)

G Balbi (G)

F Ragazzo (F)

M Pengo (M)

Commentaires et corrections

Type : ErratumIn

Références

Prina E, Ranzani OT, Torres A. Community-acquired pneumonia. Lancet. 2015;386:1097–108.

doi: 10.1016/S0140-6736(15)60733-4

File TM Jr, Marrie TJ. Burden of community-acquired pneumonia in north American adults. Postgrad Med. 2010;122:130–41.

doi: 10.3810/pgm.2010.03.2130

Restrepo MI, Reyes LF, Anzueto A. Complication of community-acquired pneumonia (including cardiac complications). Semin Respir Crit Care Med. 2016;37:897–904.

doi: 10.1055/s-0036-1593754

Restrepo MI, Reyes LF. Pneumonia as a cardiovascular disease. Respirology. 2018;23:250–9.

doi: 10.1111/resp.13233

Feldman C, Normark S, Henriques-Normark B, Anderson R. Pathogenesis and prevention of risk of cardiovascular events in patients with pneumococcal community-acquired pneumonia. J Intern Med. 2019;285:635–52.

doi: 10.1111/joim.12875

Tralhão A, Póvoa P. Cardiovascular events after community-acquired pneumonia: a global perspective with systematic review and meta-analysis of observational studies. J Clin Med. 2020;9(2):414.

doi: 10.3390/jcm9020414

Violi F, Carnevale R, Calvieri C, et al. Nox2 up-regulation is associated with an enhanced risk of atrial fibrillation in patients with pneumonia. Thorax. 2015;70:961–6.

doi: 10.1136/thoraxjnl-2015-207178

Hu YF, Chen YJ, Lin YJ, Chen SA. Inflammation and the pathogenesis of atrial fibrillation. Nat Rev Cardiol. 2015;12:230–43.

doi: 10.1038/nrcardio.2015.2

Anderson R, Nel JG, Feldman C. Multifaceted role of pneumolysin in the pathogenesis of myocardial injury in community-acquired pneumonia. Int J Mol Sci. 2018;19(4):1147.

doi: 10.3390/ijms19041147

Shenoy AT, Beno SM, Brissac T, Bell JW, Novak L, Orihuela CJ. Severity and properties of cardiac damage caused by Streptococcus pneumoniae are strain dependent. PLoS One. 2018;13(9):e0204032.

doi: 10.1371/journal.pone.0204032

Menéndez R, Méndez R, Aldás I, et al. Community-acquired pneumonia patients at risk for early and long-term cardiovascular events are identified by cardiac biomarkers. Chest. 2019;156(6):1080–91.

doi: 10.1016/j.chest.2019.06.040

Corrales-Medina VF, Musher DM, Wells GA, Chirinos JA, Chen L, Fine MJ. Cardiac complications in patients with community-acquired pneumonia: incidence, timing, risk factors, and association with short-term mortality. Circulation. 2012;125:773–81.

doi: 10.1161/CIRCULATIONAHA.111.040766

Violi F, Cangemi R, Falcone M, et al. Cardiovascular complications and short-term mortality risk in community-acquired pneumonia. Clin Infect Dis. 2017;64:1486–93.

doi: 10.1093/cid/cix164

Corrales-Medina VF, Alvarez KN, Weissfeld LA, Weissfeld LA, et al. Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease. JAMA. 2015;313:264–74.

doi: 10.1001/jama.2014.18229

Lim SW, Baudouin SV, George RC, et al. Pneumonia guidelines committee of the BTS standards of care committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009;64(Suppl III):iii1–iii55.

pubmed: 19783532

Wunderink RG, Waterer GW. Community-acquired pneumonia. N Engl J Med. 2014;370:543–51.

doi: 10.1056/NEJMcp1214869

Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1–38.

doi: 10.1038/kisup.2012.1

Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:2129–200.

doi: 10.1093/eurheartj/ehw128

Roffi M, Patrono C, Collet JP, et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:267–315.

doi: 10.1093/eurheartj/ehv320

Cilli A, Cakin O, Aksoy E, et al. Acute cardiac events in severe community-acquired pneumonia: a multicenter study. Clin Respir J. 2018;12:2212–9.

doi: 10.1111/crj.12791

Corrales-Medina VF, Suh KN, Rose G, et al. Cardiac complications in patients with community-acquired pneumonia: a systematic review and meta-analysis of observational studies. PLoS Med. 2011;8:e1001048.

doi: 10.1371/journal.pmed.1001048

Aliberti S, Ramirez JA. Cardiac diseases complicating community acquired pneumonia. Curr Opin Infect Dis. 2014;27:295–301.

doi: 10.1097/QCO.0000000000000055

Ronco C, Kellum JA, Bellomo R, House AA. Potential interventions in sepsis-related acute kidney Iinjury. Clin J Am Soc Nephrol. 2008;3:531–44.

doi: 10.2215/CJN.03830907

Mortensen EM, Halm EA, Pugh MJ. Association of azithromycin with mortality and cardiovascular events among older patients hospitalized with pneumonia. JAMA. 2014;311(21):2199–208.

doi: 10.1001/jama.2014.4304

van der Hooft CS, Heeringa J, van Herpen G, Kors JA, Kingma JH, Stricker BH. Drug-induced atrial fibrillation. J Am Coll Cardiol. 2004;44:2117–24.

doi: 10.1016/j.jacc.2004.08.053

Bolognesi M, Bolognesi D. Ciprofloxacin-induced paroxysmal atrial fibrillation. OA Case Rep. 2014;3:24.

Yende S, D’Angelo G, Kellum JA, for the GenIMS Investigators, et al. Inflammatory markers at hospital discharge predict subsequent mortality after pneumonia and sepsis. Am J Respir Crit Care Med. 2008;177:1242–7.

doi: 10.1164/rccm.200712-1777OC

Mandal P, Chalmers JD, Choudhury G, Akram AR, Hill AT. Vascular complications are associated with poor outcome in community-acquired pneumonia. QJM. 2011;104:489–95.

doi: 10.1093/qjmed/hcq247

Bosch NA, Cohen DM, Walkey AJ. Risk factors for new-onset atrial fibrillation in patients with sepsis: a systematic review and meta-analysis. Crit Care Med. 2019;47(2):280–28.

doi: 10.1097/CCM.0000000000003560