Cardiac Complications in Patients with Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis of Observational Studies
Cardiac Complications in Patients with Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis of Observational Studies
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DOI：
10.1371/journal.pmed.1001048
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发表时间：
2011-06-01
期刊：
影响因子：
15.8
通讯作者：
Fergusson, Dean A.
中科院分区：
文献类型：
--
作者：
Corrales-Medina, Vicente F.;Suh, Kathryn N.;Fergusson, Dean A.
背景：社区获得性肺炎（CAP）是发病率和死亡率的主要原因。CAP可引发急性心脏事件。我们试图确定CAP患者主要心脏并发症的发生率，以表征该问题的严重程度。方法和发现：两名研究者检索了MEDLINE、Scopus和EMBASE，以寻找具有CAP临床和放射学证据的免疫正常成人的观察性研究，这些研究报告了以下任何一项：CAP诊断后30天内发生的总体心脏并发症、心力衰竭、急性冠状动脉综合征（ACS）或心律失常。至少，研究必须建立入组程序、纳入和排除标准，按顺序入组患者，并报告心脏并发症的发生率作为整个队列的功能。未纳入以医院或卫生保健相关肺炎为重点的研究。对2176次引用的审查产生了25篇符合资格和最低质量标准的文章。17篇文章（68%）报道了CAP住院患者队列。在该组中，总心脏并发症（6个队列，2,119例患者）、心力衰竭（8个队列，4,215例患者）、急性冠状动脉综合征（6个队列，2,657例患者）和心律失常（6个队列，2,596例患者）的总发生率分别为17.7%（置信区间[CI] 13.9-22.2）、14.1%（9.3-20.6）、5.3%（3.2-8.6）和4.7%（2.4-8.9）。一篇文章报道了CAP门诊患者的心脏并发症，四篇报道了低风险（病情不严重）住院患者的心脏并发症，三篇报道了高风险住院患者的心脏并发症。除总体心脏并发症外，前两组所有结果的发生率均较低，后两组较高。另一项研究报告了CAP门诊患者和低风险住院患者，但没有对这两组进行区分。12项研究（48%）主张在其方法中评估心脏并发症，但只有6项研究（24%）提供了心脏并发症的定义。只有三项研究（都是针对ACS的）对这些事件进行了风险因素分析。没有研究分析心脏并发症和其他医学并发症之间的关系或它们对其他CAP结果的影响。结论：主要心脏并发症发生在相当大比例的CAP患者中。医生和患者需要认识到这种关联对于及时识别和管理这些事件的重要性。需要优化旨在预防高危人群肺炎（即流感和肺炎球菌疫苗接种）的战略。需要进一步的研究来了解这种关联的机制，测量心脏并发症对其他CAP结果的影响，确定那些具有心脏并发症高风险的CAP患者，并设计策略来预防这些人群发生心脏并发症。
Background: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality. CAP can trigger acute cardiac events. We sought to determine the incidence of major cardiac complications in CAP patients to characterize the magnitude of this problem.Methods and Findings: Two investigators searched MEDLINE, Scopus, and EMBASE for observational studies of immunocompetent adults with clinical and radiological evidence of CAP that reported any of the following: overall cardiac complications, incident heart failure, acute coronary syndromes (ACS), or incident cardiac arrhythmias occurring within 30 days of CAP diagnosis. At a minimum, studies had to establish enrolment procedures and inclusion and exclusion criteria, enrol their patients sequentially, and report the incidence of cardiac complications as a function of their entire cohorts. Studies with focus on nosocomial or health care-associated pneumonia were not included. Review of 2,176 citations yielded 25 articles that met eligibility and minimum quality criteria. Seventeen articles (68%) reported cohorts of CAP inpatients. In this group, the pooled incidence rates for overall cardiac complications (six cohorts, 2,119 patients), incident heart failure (eights cohorts, 4,215 patients), acute coronary syndromes (six cohorts, 2,657 patients), and incident cardiac arrhythmias (six cohorts, 2,596 patients), were 17.7% (confidence interval [CI] 13.9-22.2), 14.1% (9.3-20.6), 5.3% (3.2-8.6), and 4.7% (2.4-8.9), respectively. One article reported cardiac complications in CAP outpatients, four in low-risk (not severely ill) inpatients, and three in high-risk inpatients. The incidences for all outcomes except overall cardiac complications were lower in the two former groups and higher in the latter. One additional study reported on CAP outpatients and low-risk inpatients without discriminating between these groups. Twelve studies (48%) asserted the evaluation of cardiac complications in their methods but only six (24%) provided a definition for them. Only three studies, all examining ACS, carried out risk factor analysis for these events. No study analyzed the association between cardiac complications and other medical complications or their impact on other CAP outcomes.Conclusions: Major cardiac complications occur in a substantial proportion of patients with CAP. Physicians and patients need to appreciate the significance of this association for timely recognition and management of these events. Strategies aimed at preventing pneumonia (i.e., influenza and pneumococcal vaccination) in high-risk populations need to be optimized. Further research is needed to understand the mechanisms underlying this association, measure the impact of cardiac complications on other CAP outcomes, identify those patients with CAP at high risk of developing cardiac complications, and design strategies to prevent their occurrence in this population.