Inpatient and Outpatient Infection as a Trigger of Cardiovascular Disease: The ARIC Study
Inpatient and Outpatient Infection as a Trigger of Cardiovascular Disease: The ARIC Study
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DOI：
10.1161/jaha.118.009683
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发表时间：
2018-11-20
影响因子：
5.4
通讯作者：
Lakshminarayan, Kamakshi
中科院分区：
文献类型：
--
作者：
Cowan, Logan T.;Lutsey, Pamela L.;Lakshminarayan, Kamakshi
背景--急性感染是已知的心血管疾病（CVD）的触发因素，但关于住院患者与门诊患者感染后CVD风险的变化知之甚少。我们假设，在和门诊感染与心血管疾病的风险和关联是更强的住院infecties.Methods和Results-Coronary Heart Disease（CHD）和缺血性中风的情况下，确定和裁定的ARIC（动脉粥样硬化风险在社区研究）。医院出院诊断代码和医疗保险索赔数据被用来识别在住院和门诊诊断的感染。采用病例交叉设计和条件Logistic回归分析比较CHD和缺血性卒中病例（事件发生前14、30、42和90天）与相应对照期1年和2年前的院内和门诊感染。共分析了1312例新发冠心病病例和727例新发卒中病例。住院感染（14天比值比[OR]=12.83 [5.74，28.68]，30天OR=8.39 [4.92，14.31]，42天OR=6.24 [4.02，9.67]和90天OR=4.48 [3.18，6.33]）和门诊感染（14天OR=3.29 [2.50，4.32]，30天OR=2.69 [2.14，3.37]，42天OR=2.45 [1.97，3.05]和90天OR=1.99 [1.64，2.42]）在所有CHD病例期较对照期更常见，住院感染是所有时间段更强的CHD触发因素（P
Background-Acute infections are known cardiovascular disease (CVD) triggers, but little is known regarding how CVD risk varies following inpatient versus outpatient infections. We hypothesized that in-and outpatient infections are associated with CVD risk and that the association is stronger for inpatient infections.Methods and Results-Coronary heart disease (CHD) and ischemic stroke cases were identified and adjudicated in the ARIC (Atherosclerosis Risk in Communities Study). Hospital discharge diagnosis codes and Medicare claims data were used to identify infections diagnosed in in-and outpatient settings. A case-crossover design and conditional logistic regression were used to compare in-and outpatient infections among CHD and ischemic stroke cases (14, 30, 42, and 90 days before the event) with corresponding control periods 1 and 2 years previously. A total of 1312 incident CHD cases and 727 incident stroke cases were analyzed. Inpatient infections (14-day odds ratio [OR]=12.83 [5.74, 28.68], 30-day OR=8.39 [4.92, 14.31], 42-day OR=6.24 [4.02, 9.67], and 90-day OR=4.48 [3.18, 6.33]) and outpatient infections (14-day OR=3.29 [2.50, 4.32], 30-day OR=2.69 [2.14, 3.37], 42-day OR=2.45 [1.97, 3.05], and 90-day OR=1.99 [1.64, 2.42]) were more common in all CHD case periods compared with control periods and inpatient infection was a stronger CHD trigger for all time periods (P