Prognostic Factors for Cardiovascular Events in Elderly Patients with Community Acquired Pneumonia: Results from the CAP-China Network

Abstract

Background Limited data were available about the burden of cardiovascular events (CVEs) during hospitalization in elderly patients with community-acquired pneumonia (CAP). The aim was to assess the incidence, characteristics, predictive factors and outcomes of CVEs in elderly patients with CAP during hospitalization. Methods This study was a multicenter, retrospective research on hospitalized elderly patients with CAP from the CAP-China network. Predictive factors for the occurrence of CVEs and 30-day mortality were identified by multivariable logistic regression analysis. Results Of 2941 hospitalized elderly patients, 402 (13.7%) developed CVEs during hospitalization with the median age of 81 years old. Compared with non-CVEs patients, patients with CVEs were older, more comorbidities, and higher disease severity; use of glucocorticoids, leukocytosis, azotemia, hyponatremia, multilobe infiltration and pleural effusion were more common; the rate of clinical failure (CF), in-hospital mortality and 30-day mortality were higher, which significantly increased with age and the number of CVEs (p < 0.001). Multivariable logistic regression showed previous history of congestive heart failure (odds ratio [OR], 6.16; 95% CI, 4.14–9.18), CF (OR, 4.69; 95% CI, 3.392–6.48), previous history of ischemic heart disease (OR, 2.22; 95% CI, 1.61–3.07), use of glucocorticoids (OR, 2.0; 95% CI, 1.39–2.89), aspiration (OR, 1.88; 95% CI, 1.26–2.81), pleural effusion (OR, 1.66; 95% CI, 1.25–2.20), multilobe infiltration (OR, 1.50; 95% CI, 1.15–1.96), age (OR, 1.05; 95% CI, 1.04–1.07), and blood urea nitrogen (OR, 1.03; 95% CI, 1.01–1.06) were independent predictors for the occurrence of CVEs, while level of blood sodium (OR, 0.98; 95% CI, 0.97–0.99) was protective factor. Renal failure (OR, 9.46; 95% CI, 4.17–21.48), respiratory failure (OR, 9.32; 95% CI, 5.91–14.71), sepsis/septic shock (OR, 7.87; 95% CI, 3.58–17.31), new cerebrovascular diseases (OR, 5.94; 95% CI, 1.78–19.87), new heart failure (OR, 4.04; 95% CI, 1.15–14.14), new arrhythmia (OR, 2.38; 95% CI, 1.11–5.14), aspiration (OR, 1.95; 95% CI, 1.09–3.50), CURB-65 (OR, 1.57; 95% CI, 1.21–2.02), and white blood cell count (OR, 1.05; 95% CI, 1.02–1.09) were independent predictors for 30-day mortality in elderly patients with CAP, while lymphocyte count (OR, 0.63; 95% CI, 0.46–0.87) was protective factor. Conclusion Patients with CVEs had heavier disease burden and worse prognosis. Early recognition of risk factors is meaningful to strengthen the management in elderly patients with CAP.

Prevalence of new-onset atrial fibrillation in hospitalized patients with community-acquired pneumonia: a systematic review and meta-analysis

“…Other factors may contribute to the findings observed, beyond the pathophysiological mechanisms already described. Particularly, is it possible that patients with CAP requiring hospitalization have a higher burden of cardiovascular comorbidities and risk factors, with a subsequently higher risk of developing cardiovascular complications during the in-hospital stay, including newAF [ 37 ]. This hypothesis is consistent with the observation of lower rates of cardiovascular complications in CAP outpatients [ 38 ], suggesting that newAF—beyond being directly triggered by CAP—may also represent a marker of increased clinical complexity, and may be influenced by the severity of the underlying disease [ 39 ].…”