Cardiovascular Complications and Short-term Mortality Risk in Community-Acquired Pneumonia
Cardiovascular Complications and Short-term Mortality Risk in Community-Acquired Pneumonia
复制标题
DOI：
10.1093/cid/cix164
复制
发表时间：
2017-06-01
影响因子：
11.8
通讯作者：
Corrales-Medina, Vicente F.
中科院分区：
文献类型：
--
作者：
Violi, Francesco;Cangemi, Roberto;Corrales-Medina, Vicente F.
背景。先前的报告表明，社区获得性肺炎（CAP）与心血管并发症的风险增加有关。然而，缺乏对这种关联的当代和全面的表征方法。在这项多中心研究中，1182 名因 CAP 住院的患者在因感染住院后进行了长达 30 天的前瞻性随访。研究终点包括心肌梗塞、新发或恶化的心力衰竭、心房颤动、中风、深静脉血栓形成、心血管死亡和总死亡率。结果。 380 例（32.2%）患者发生院内心血管事件（CVE），其中心力衰竭 281 例（23.8%）、房颤 109 例（9.2%）、心肌梗死 89 例（8%）、缺血性卒中 11 例（0.9%）、深静脉血栓 1 例（0.1%）； 28 名患者 (2.4%) 死于心血管原因。多变量 Cox 回归分析显示，院内肺炎严重程度指数 (PSI) 类别（风险比 [HR]，2.45，P = .027；HR，4.23，P < .001；HR，5.96，P < .001，分别为 III、IV 和 V 级与 II 级）、年龄（HR，1.02，P = .001）和先前存在的心力衰竭（HR，1.85，P < .001）独立预测 CVE。入院后第 30 天，有 103 名患者 (8.7%) 死亡。与未发生 CVE 的患者相比，发生 CVE 的患者的 30 天死亡率显着更高（17.6% vs 4.5%，P < .001）。多变量 Cox 回归分析显示，院内 CVE（HR，5.49，P < .001）独立预测 30 天死亡率（调整年龄、PSI 评分和既往合并症后）。结论。 CVE（主要是局限于心脏的 CVE）使近三分之一因 CAP 住院的患者的病程变得复杂。更重要的是，CVE 的发生与 CAP 相关的 30 天死亡率增加 5 倍相关。
Background. Previous reports suggest that community-acquired pneumonia (CAP) is associated with an enhanced risk of cardiovascular complications. However, a contemporary and comprehensive characterization of this association is lacking.Methods. In this multicenter study, 1182 patients hospitalized for CAP were prospectively followed for up to 30 days after their hospitalization for this infection. Study endpoints included myocardial infarction, new or worsening heart failure, atrial fibrillation, stroke, deep venous thrombosis, cardiovascular death, and total mortality.Results. Three hundred eighty (32.2%) patients experienced intrahospital cardiovascular events (CVEs) including 281 (23.8%) with heart failure, 109 (9.2%) with atrial fibrillation, 89 (8%) with myocardial infarction, 11 (0.9%) with ischemic stroke, and 1 (0.1%) with deep venous thrombosis; 28 patients (2.4%) died for cardiovascular causes. Multivariable Cox regression analysis showed that intrahospital Pneumonia Severity Index (PSI) class (hazard ratio [HR], 2.45, P = .027; HR, 4.23, P < .001; HR, 5.96, P < .001, for classes III, IV, and V vs II, respectively), age (HR, 1.02, P = .001), and preexisting heart failure (HR, 1.85, P < .001) independently predicted CVEs. One hundred three (8.7%) patients died by day 30 postadmission. Thirty-day mortality was significantly higher in patients who developed CVEs compared with those who did not (17.6% vs 4.5%, P < .001). Multivariable Cox regression analysis showed that intrahospital CVEs (HR, 5.49, P < .001) independently predicted 30-day mortality (after adjustment for age, PSI score, and preexisting comorbid conditions).Conclusions. CVEs, mainly those confined to the heart, complicate the course of almost one-third of patients hospitalized for CAP. More importantly, the occurrence of CVEs is associated with a 5-fold increase in CAP-associated 30-day mortality.