Chest
Original Research: Chest InfectionsCommunity-Acquired Pneumonia Patients at Risk for Early and Long-term Cardiovascular Events Are Identified by Cardiac Biomarkers
Section snippets
Prospective Cohort Multicenter Study
A prospective multicenter study was performed of patients with CAP hospitalized at three hospitals affiliated with the Spanish National Health Service. The inclusion criterion was a diagnosis of pneumonia based on a new radiological infiltrate with at least two compatible clinical symptoms. Exclusion criteria were admission in the previous 15 days, residence in a nursing home, immunosuppressive treatments, and HIV-positive status. The study complied with the Declaration of Helsinki, it was
Patients’ Characteristics and Cardiovascular Events
We recruited 920 patients and ultimately included 730 patients, with a median age of 70 years (interquartile range, 55-80 years). Ninety-five patients presented with an early event and 67 with late cardiovascular events (Table 1); 20 patients had both early and late events. Patients with early cardiovascular events were older and presented more previous cardiac diseases, more sepsis, and more previous treatment with statins (Table 2).
Mortality in the whole cohort was as follows: 4.7% (n = 34)
Discussion
The most relevant results of our study are as follows: (1) cardiac biomarkers are independently related to early and long-term cardiovascular events after controlling for age, sepsis, Pao2/Fio2 < 250 mm Hg, and previous heart diseases; (2) for early events, cardiac biomarkers measured on day 1 show similar ORs (proBNP, 2.67; troponin T, 2.70; proADM, 2.53; and proendothelin-1, 2.25); and (3) for late cardiovascular events, a combination of IL-6 levels at day 30 to proendothelin-1 or proADM
Conclusions
The current study shows the usefulness of cardiac biomarker levels at day 1 to predict early cardiovascular events and at day 30 to predict late cardiovascular events even in patients with no previous cardiac diseases. Some patients still have high levels of inflammatory and cardiac biomarkers at 30 days, when they are usually referred to primary care without receiving any specific additional recommendations. Our results suggest that a change in usual practice is needed to reduce current and
Acknowledgments
Author contributions: R. Menéndez conceived the study design. R. Méndez, I. A., S. R., P. G.-J., P. P. E., and J. A. developed and recruited cohorts that were used in the study. R. Méndez, I. A., S. R., P. G.-J., P. P. E., and J. A. collected the data used in the study. M. S. and R. A. performed the laboratory analysis of the biological samples. R. Menéndez, R. Méndez, and L. M.-D. analyzed the data. L. M.-D. and A. T. contributed to interpretation of results. R. Menéndez wrote the manuscript.
References (38)
- et al.
Community-acquired pneumonia
Lancet
(2015) - et al.
Decrease in long-term survival for hospitalized patients with community-acquired pneumonia
Chest
(2010) - et al.
Community-acquired pneumonia: pathogenesis of acute cardiac events and potential adjunctive therapies
Chest
(2015) - et al.
Endothelin-1 and its role in the pathogenesis of infectious diseases
Life Sci
(2014) - et al.
Cardiac troponin I as a prognostic factor in critically ill pneumonia patients in the absence of acute coronary syndrome
J Crit Care
(2015) - et al.
Pneumonia presenting with organ dysfunctions: causative microorganisms, host factors and outcome
J Infect
(2016) - et al.
Direct comparison of three natriuretic peptides for prediction of short- and long-term mortality in patients with community-acquired pneumonia
Chest
(2012) - et al.
Prognostic value of brain natriuretic peptide in heart transplant patients
J Heart Lung Transplant
(2007) - et al.
Cardiac troponin elevation in patients without a specific diagnosis
J Am Coll Cardiol
(2019) - et al.
Circulating interleukin-6 levels and cardiovascular and all-cause mortality in the elderly population: a meta-analysis
Arch Gerontol Geriatr
(2017)
Dabigatran in Patients with Myocardial Injury After Non-Cardiac Surgery (MANAGE): an international, randomised, placebo-controlled trial
Lancet
Ticagrelor reduces thromboinflammatory markers in patients with pneumonia
JACC Basic Transl Sci
Assessment of mortality after long-term follow-up of patients with community-acquired pneumonia
Clin Infect Dis
Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease
JAMA
Acute myocardial infarction versus other cardiovascular events in community-acquired pneumonia
ERJ Open Res
Acute myocardial infarction in hospitalized patients with community-acquired pneumonia
Clin Infect Dis
Cardiovascular complications and short-term mortality risk in community-acquired pneumonia
Clin Infect Dis
Cardiac diseases complicating community-acquired pneumonia
Curr Opin Infect Dis
Intermediate and long-term risk of new-onset heart failure after hospitalization for pneumonia in elderly adults
Am Heart J
Cited by (0)
FUNDING/SUPPORT: This work was supported by the following: Instituto de Salud Carlos III through the Project PI13/00583 (co-funded by European Regional Development Fund/European Social Fund, “Investing in your future”) [PI13/00583]; Sociedad Española de Neumología y Cirugía Torácica (SEPAR) [166/2013 and 501/2017]; and the Center for Biomedical Research Network in Respiratory Diseases (CIBERES) [CB06/06/0028].