The incidence of cardiovascular events after hospitalization due to CAP and their association with different inflammatory markers

Abstract

BackgroundLate prognosis of Community-Acquired Pneumonia (CAP) patients is related to cardiovascular events. Persistence of inflammation-related markers, defined by high circulatory levels of interleukin 6 and 10 (IL-6/IL-10), is associated with a higher post-event mortality rate for CAP patients. However, association between these markers and other components of the immune response, and the risk of cardiovascular events, has not been adequately explored. The main objectives of this study are: 1) to quantify the incidence of cardiovascular disease, in the year post-dating their hospital admittance due to CAP and, 2) to describe the distribution patterns of a wide spectrum of inflammatory markers upon admittance to and release from hospital, and to determine their relationship with the incidence of cardiovascular disease.Methods/designA cohort prospective study. All patients diagnosed and hospitalized with CAP will be candidates for inclusion. The study will take place in the Universitary Hospital La Princesa, Spain, during two years. Two samples of blood will be taken from each patient: the first upon admittance and the second one prior to release, in order to analyse various immune agents. The main determinants are: pro-adrenomedullin, copeptin, IL-1, IL-6, TNF-α, IL-17, IFN-γ, IL-10 and TGF-β, E-Selectin, ICAM-1, VCAM-1 and subpopulations of peripheral T lymphocytes (T regulator, Th1 and Th17), together with other clinical and analytical variables. Follow up will start at admittance and finish a year after discharge, registering incidence of death and cardiovascular events. The main objective is to establish the predictive power of different inflammatory markers in the prognosis of CAP, in the short and long term, and their relationship with cardiovascular disease.DiscussionThe level of some inflammatory markers (IL-6/IL-10) has been proposed as a means to differentiate the degree of severity of CAP, but their association with cardiovascular risk is not well established. In this study we aim to define new inflammatory markers associated with cardiovascular disease that could be helpful for the prognosis of CAP patients, by describing the distribution of a wide spectrum of inflammatory mediators and analyzing their association with the incidence of cardiovascular disease and mortality one year after release from hospital.

Cytokines and Cortisol – predictors of treatment response to corticosteroids in community‐acquired pneumonia?

“…High inflammation state reflected by increased cytokine levels has found to be associated with an increased risk for cardiovascular events in patients with CAP . Cardiovascular events occur both in the acute but also in the long‐term phase of CAP contributing to an increased short‐ and long‐term mortality .…”

“…As our study was not powered for this research question, these events should be regarded with caution. In fact, there are ongoing prospective studies addressing this particular research question .…”

Usefulness of circulating microRNAs miR-146a and miR-16-5p as prognostic biomarkers in community-acquired pneumonia

“…All the data generated during this research are openly available in the public repository of Zenodo.org [ https://doi.org/10.5281/zenodo.3930832 ]. Furthermore, the methodology followed can be found in the previously published protocol [ 25 ].…”

Pathogenesis and prevention of risk of cardiovascular events in patients with pneumococcal community‐acquired pneumonia

“…Rajas and colleagues, who noted that studies have indicated that the late prognosis of CAP is frequently related to CVEs, and that persistence of inflammatory markers is associated with higher long‐term mortality from CAP, have published a protocol outlining a proposed study designed to investigate this relationship further . In this prospective cohort study, various inflammatory markers will be measured in patients with CAP on admission and prior to discharge and the primary purpose will be to determine the ability of these inflammatory markers to predict both short‐term and long‐term prognosis in patients with CAP and to evaluate their relationship with CVEs.…”