What is the Association of Cardiovascular Events with Clinical Failure in Patients with Community-Acquired Pneumonia?

doi:10.1016/j.idc.2012.11.010

Infectious Disease Clinics of North America

Volume 27, Issue 1, March 2013, Pages 205-210

https://doi.org/10.1016/j.idc.2012.11.010 Get rights and content

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Key points

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An increased risk of cardiovascular events (CVEs) in hospitalized patients with community-acquired pneumonia (CAP) was recently reported.
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CVEs may be the primary determinant of clinical failure in hospitalized patients with CAP.
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Therapeutics beyond antibiotics (eg, heparin or aspirin) may be indicated during and after hospitalization.

Definitions of clinical failure and CVEs

Different criteria have been used by different investigators to define the presence of clinical failure in hospitalized patients with CAP.⁶ Using a pathophysiologic approach, clinical failure can be characterized as being related to either CAP or the management of CAP (Fig. 1).⁷ Clinical failure related to CAP is explained by the pathophysiology of the pulmonary infection with its associated local and systemic inflammatory response. Clinical failure related to CAP may develop from the

CVEs and clinical failure within 30 days’ follow-up

Most studies evaluating the association between CVEs and CAP have evaluated patients during hospitalization. Some of these studies evaluated the incidence of CVEs during hospitalization for CAP, whereas others also included the association between CVEs and clinical outcomes. Of these, only one study reported data on clinical failure.⁷

In a retrospective cohort study of 170 consecutive patients hospitalized for pneumococcal pneumonia, almost 20% developed CVEs, which included AMI, serious

CVEs and clinical failure at long-term follow-up

Although several articles reported increased long-term mortality in hospitalized patients with CAP,14, 15 CVEs were only recently implicated as one of the possible explanations for this increased mortality.11, 16, 17, 18 In a study designed to understanding mechanisms and predictors of increased long-term mortality, the authors evaluated the association between serum markers of inflammation and mortality within the first year after an episode of pneumonia.¹⁶ This study reported CVE as the first

Summary

Increased incidence of CVEs associated with increased clinical failure and mortality rates has been documented in hospitalized patients with CAP.

Investigators have hypothesized that the increased risk of CVEs in this population is partly from atherosclerotic plaque instability related to the systemic inflammation from the pneumonia. This close relationship between CAP and CVEs is further evidenced by the seasonality of both processes and the reduction of CVEs seen after vaccination for

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Cited by (10)

Early and Late Cardiovascular Events in Patients Hospitalized for Community-Acquired Pneumonia
2020, Archivos de Bronconeumologia
La neumonía adquirida en la comunidad se asocia al desarrollo de eventos cardiovasculares (ECV). El objetivo del estudio fue analizar los factores relativos al huésped, la gravedad y la etiología que se asocian con la aparición de estos eventos, tempranos y tardíos, y su impacto en la mortalidad.
Estudio prospectivo de cohortes multicéntrico en pacientes ingresados por neumonía. Se recogieron ECV durante el ingreso, a los 30 días (tempranos) y al año (tardíos) y la mortalidad.
Doscientos dos de 1.967 (10,42%) pacientes presentaron ECV tempranos y 122 (6,64%) tardíos. El 16% de la mortalidad al año se atribuyó a complicaciones cardiovasculares. Los factores del huésped relacionados con complicaciones cardiovasculares fueron: edad ≥ 65 años, abuso de alcohol, tabaquismo y cardiopatía crónica en los tempranos y obesidad, HTA e insuficiencia renal crónica en los tardíos. La presencia de sepsis grave y Pneumonia Severity Index (PSI) ≥ 3 fueron factores de riesgo independiente de eventos tempranos y, únicamente, el PSI ≥ 3 de los tardíos. Streptococcus pneumoniae fue el microorganismo con mayor riesgo de complicaciones cardiovasculares. Desarrollar un ECV fue factor independiente de mortalidad temprana (OR 2,37) y tardía (OR 4,05).
La edad, el tabaquismo, la cardiopatía, la gravedad inicial y el S. pneumoniae son factores de riesgo de presentar ECV tempranos y tardíos, lo que conlleva mayor mortalidad durante y tras el episodio agudo de neumonía. Conocer estos factores puede ser de utilidad para desarrollar estrategias activas de diagnóstico precoz de eventos y/o diseñar ensayos dirigidos a reducir las complicaciones cardiovasculares.
Community-acquired pneumonia increases the risk of cardiovascular events (CVE). The objective of this study was to analyze host, severity, and etiology factors associated with the appearance of early and late events and their impact on mortality.
Prospective multicenter cohort study in patients hospitalized for pneumonia. CVE and mortality rates were collected at admission, 30-day follow-up (early events), and one-year follow-up (late events).
In total, 202 of 1,967 (10.42%) patients presented early CVE and 122 (6.64%) late events; 16% of 1-year mortality was attributed to cardiovascular disease. The host risk factors related to cardiovascular complications were: age ≥ 65 years, smoking, and chronic heart disease. Alcohol abuse was a risk factor for early events, whereas obesity, hypertension, and chronic renal failure were related to late events. Severe sepsis and Pneumonia Severity Index (PSI) ≥ 3 were independent risk factors for early events, and only PSI ≥ 3 for late events. Streptococcus pneumoniae was the microorganism associated with most cardiovascular complications. Developing CVE was an independent factor related to early (OR 2.37) and late mortality (OR 4.05).
Age, smoking, chronic heart disease, initial severity, and S. pneumoniae infection are risk factors for early and late events, complications that have been related with an increase of the mortality risk during and after the pneumonia episode. Awareness of these factors can help us make active and early diagnoses of CVE in hospitalized CAP patients and design future interventional studies to reduce cardiovascular risk.
The management of community-acquired pneumonia in the elderly
2014, European Journal of Internal Medicine
Citation Excerpt :
The most common causes of clinical failure were severe sepsis, myocardial infarction (MI), progressive pneumonia and HAP [67]. Several authors have recently reported an increased risk of cardiovascular events in hospitalized patients with CAP [68,69]. A meta-analysis by Corrales-Medina et al. highlighted how common cardiovascular events are among patients with pneumonia, with an overall cardiac events rate of 18% in the 17 studies evaluated [70].
Pneumonia is one of the main causes of morbidity and mortality in the elderly. The elderly population has exponentially increased in the last decades and the current epidemiological trends indicate that it is expected to further increase. Therefore, recognizing the special needs of older people is of paramount importance. In this review we address the main differences between elderly and adult patients with pneumonia. We focus on several aspects, including the atypical clinical presentation of pneumonia in the elderly, the methods to assess severity of illness, the appropriate setting of care, and the management of comorbidities. We also discuss how to approach the common complications of severe pneumonia, including acute respiratory failure and severe sepsis. Moreover, we debate whether or not elderly patients are at higher risk of infection due to multi-drug resistant pathogens and which risk factors should be considered when choosing the antibiotic therapy. We highlight the differences in the definition of clinical stability and treatment failure between adults and elderly patients. Finally, we review the main outcomes, preventive and supportive measures to be considered in elderly patients with pneumonia.
Acute cardiac complications in patients admitted with Community-acquired pneumonia in an Internal Medicine ward
2023, Research Square
Drug Repositioning with GraphSAGE and Clustering Constraints Based on Drug and Disease Networks
2022, Frontiers in Pharmacology
Pneumonia and its cardiovascular complications
2022, Studia Pneumologica et Phthiseologica
Severe pneumonia and acute myocardial infarction complicated with pericarditis after percutaneous coronary intervention: A case report
2022, World Journal of Clinical Cases

View all citing articles on Scopus

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What is the Association of Cardiovascular Events with Clinical Failure in Patients with Community-Acquired Pneumonia?

Section snippets

Key points

Definitions of clinical failure and CVEs

CVEs and clinical failure within 30 days’ follow-up

CVEs and clinical failure at long-term follow-up

Summary

First page preview

Am Heart J

Chest

Chest

Lancet Infect Dis

Is community-acquired pneumonia an independent risk factor for cardiovascular disease?

Eur Respir J

Risk stratification and prognosis of acute cardiac events in hospitalized adults with community-acquired pneumonia

J Infect

Deaths: leading causes for 2008

Natl Vital Stat Rep

Clinical stability versus clinical failure in patients with community-acquired pneumonia

Semin Respir Crit Care Med