Acute cardiovascular events in patients with community acquired pneumonia: results from the observational prospective FADOI-ICECAP study

Filippo Pieralli,Vieri Vannucchi,Laura Morbidoni,Mauro Campanini,Francesco Corradi,Filippo Risaliti,Andrea Fontanella,Carlo Nozzoli,Giulia De Marzi,Generoso Uomo,Daniela Tirotta,Riccardo Gerloni,Paola Gnerre,Antonino Mazzone,Giuseppe Augello,Gualberto Gussoni,Claudio Santini ,Francesco Dentali,Antonella Valerio,Dario Manfellotto

doi:10.1186/s12879-021-05781-w

Abstract

BackgroundThe burden of cardiovascular (CV) complications in patients hospitalised for community-acquired pneumonia (CAP) is still uncertain. Available studies used different designs and different criteria to define CV complications. We assessed the cumulative incidence of acute of CV complications during hospitalisation for CAP in Internal Medicine Units (IMUs).MethodsThis was a prospective study carried out in 26 IMUs, enrolling patients consecutively hospitalised for CAP. Defined CV complications were: newly diagnosed heart failure, acute coronary syndrome, new onset of supraventricular or ventricular arrhythmias, new onset hemorrhagic or ischemic stroke or transient ischemic attack. Outcome measures were: in-hospital and 30-day mortality, length of hospital stay and rate of 30-day re-hospitalisation.ResultsA total of 1266 patients were enrolled, of these 23.8% experienced at least a CV event, the majority (15.5%) represented by newly diagnosed decompensated heart failure, and 75% occurring within 3 days. Female gender, a history of CV disease, and more severe pneumonia were predictors of CV events. In-hospital (12.2% vs 4.7%, p < 0.0001) and 30-day (16.3% vs 8.9%, p = 0.0001) mortality was higher in patients with CV events, as well as the re-hospitalisation rate (13.3% vs 9.3%, p = 0.002), and mean hospital stay was 11.4 ± 6.9 vs 9.5 ± 5.6 days (p < 0.0001). The occurrence of CV events during hospitalisation significantly increased the risk of 30-day mortality (HR 1.69, 95% CI 1.14–2.51; p = 0.009).ConclusionCardiovascular events are frequent in CAP, and their occurrence adversely affects outcome. A strict monitoring might be useful to intercept in-hospital CV complications for those patients with higher risk profile.Trial registrationNCT03798457Registered 10 January 2019 - Retrospectively registered

Highlights

Community acquired pneumonia (CAP) is a frequent and clinically demanding infection [1, 2], and a leading cause of hospitalisation in Internal Medicine wards
Patients were excluded from the study if they met criteria for hospital-acquired pneumonia (HAP), and/or if they were severely immunocompromised, or refused or were unable to give consent to participate in the study
The prevalence of comorbidities was high, with roughly one-fifth of the population having more than 3 comorbidities, mainly represented by CV diseases, chronic obstructive pulmonary disease (COPD), diabetes and moderate-severe chronic kidney disease (Table 1)

Summary

Introduction

Community acquired pneumonia (CAP) is a frequent and clinically demanding infection [1, 2], and a leading cause of hospitalisation in Internal Medicine wards. Agents causing CAP can induce direct and indirect effects on the CV system. Infections induce a significant inflammatory response with the production and release of several mediators which can determine systemic effects such as activation of coagulation, enhanced platelets aggregation, and myocardial injury [7]. S. pneumoniae, the most frequent bacterial agent of CAP, determines cardiotoxicity mainly through the activity of pneumolysin, with direct consequences on myocardial injury [9, 10]. The burden of cardiovascular (CV) complications in patients hospitalised for community-acquired pneumonia (CAP) is still uncertain. We assessed the cumulative incidence of acute of CV complications during hospitalisation for CAP in Internal Medicine Units (IMUs)

Methods

Results

Conclusion