Abstract
BackgroundAlterations of cardiac autonomic control (CAC) are associated with poor outcomes in patients with infectious and non-infectious diseases. No evaluation of CAC in patients with community-acquired pneumonia (CAP) has been performed so far. The aim of the study was to assess CAC in patients with CAP and evaluate the impact of its alterations on disease severity and clinical outcomes in a multicenter, prospective, observational study.MethodsConsecutive patients hospitalized for CAP were enrolled between 2011 and 2013 two university hospitals in Italy. CAC was assessed by linear spectral and non-linear symbolic analysis of heart rate variability. The presence of severe CAP was evaluated on hospital admission. The primary study outcome was time to clinical stability (TCS) during hospitalization.ResultsAmong the 75 patients enrolled (median age: 75 years; 57 % males), a significantly lower total variability and reduction of sympathetic rhythmical component with predominant respiratory modulation was detected in comparison to controls. Among CAP patients affected by a severe CAP on admission, CAC showed a lower sympathetic modulation and predominant parasympathetic oscillatory rhythm. At the multivariate analysis, variables independently correlated with a TCS >7 days were total power, as marker of total variability, [OR (95 % CI): 0.997 (0.994–1.000), p = 0.0454] and sympathetic modulation [OR (95 % CI): 0.964 (0.932–0.998), p = 0.0367].ConclusionsLoss of sympathetic rhythmical oscillation is associated with a more severe disease and worse early clinical outcome in hospitalized patients with CAP.Electronic supplementary materialThe online version of this article (doi:10.1186/s12931-016-0414-8) contains supplementary material, which is available to authorized users.
Highlights
Alterations of cardiac autonomic control (CAC) are associated with poor outcomes in patients with infectious and non-infectious diseases
Patients with at least one among the following were excluded from the study: 1) pneumonia that developed in a patient who was discharged from the hospital within the prior 14 days of hospital admission; 2) absence of sinus rhythm on ECG at hospital admission; 3) patients with pacemaker rhythm on ECG at hospital admission; 5) patients undergoing mechanical ventilation, in whom the application of a positive pressure might alter the evaluation of CAC; 6) patients on chronic treatment with inhaled long acting either muscarinic agents (LAMA) or beta agonists
Cardiac autonomic control in community-acquired pneumonia (CAP) patients In comparison to controls, CAP patients were characterized by significantly higher heart rate (HR) and by a significant reduction of total variability, as shown by lower level of total power and very low frequency component (VLF) component
Summary
Alterations of cardiac autonomic control (CAC) are associated with poor outcomes in patients with infectious and non-infectious diseases. It has been hypothesized that an alteration of cardiac autonomic control (CAC), as assessed by heart rate variability (HRV), may play a key role among the complex interaction of events that may lead to the occurrence of CVE during CAP [4,5,6,7,8]. This alteration is characterized by a reduction of total variability and an altered sympathovagal balance.
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