CARDIOVASCULAR DISEASE AFTER PNEUMOCOCCAL PNEUMONIA

Abstract

Objective: The purpose of this study was to assess the impact of arterial hypertension (AH) and dyslipidemia on the severity, cardiovascular events and death in patients hospitalized for pneumococcal community acquired pneumonia (CAP). Design and method: Retrospective, cohort, multicenter, epidemiologic study. All adult inpatients of 4 different centres in Portugal, with microbiological and clinical documented pneumococcal CAP were included. Demographic data, comorbidities, antibiotic therapy, hospital length of stay, need for ICU admission, invasive mechanical ventilation (IMV) and renal replacement therapy (RRT) were collected. All patients were monitored until death or 1-year of follow up. Risk factors for short- and long-term all-cause mortality, including cardiovascular events, were computed. Patients were divided into 3 groups: H) with isolated AH; HD) with both AH and dyslipidemia; Control) without AH or dyslipidemia. The significance level was defined as p <0.05. Results: 797 patients were included in this study, 53.6% male, mean age 72.4±16.5 years. Comparing the 3 groups, females were prevalent in H and HD groups (52% and 54.3% vs 40.6% Control; p<0.002). Mean age was higher in H and HD (78.2±12.6 and 78.4±10.7 years; vs Control 67.5±18.2 years, ANOVA p<0.001). 18.8% patients required ICU admission, 6.7% IMV and 13.1% RRT. H required more IMV (7.5%, p = 0,5) and HD more RRT (16.6%, p = 0.2). The overall in-hospital mortality was 17.8%. During the follow up, H and HD groups were more readmitted to the emergency department due to cardiovascular events than Control group (11.7% and 13.4% vs. 6.5%, OR 1,91 p = 0.04 and OR 2.26 p = 0.016, respectively); also required more hospitalization for cardiovascular events than Control group (14.4% e 12.6% vs. 6.2%; OR 2.49, p = 0.002; and OR 1.99, p = 0.02, respectively). One-year all-cause mortality was higher in H group (39.2%; p = 0.026). Conclusions: Prevalence of arterial hypertension was 47.4%, higher than the national rate. H group resorted, with or without dyslipidemia, more often to the emergency department, requiring more hospitalization and with higher mortality rates, without difference in hospital mortality. It's crucial to control cardiovascular risk factors, providing greater cardiovascular protection to reduce the risk of long-term mortality.