Chest
Volume 156, Issue 6, December 2019, Pages 1080-1091
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Original Research: Chest Infections
Community-Acquired Pneumonia Patients at Risk for Early and Long-term Cardiovascular Events Are Identified by Cardiac Biomarkers

https://doi.org/10.1016/j.chest.2019.06.040Get rights and content

Background

Community-acquired pneumonia (CAP) increases the risk of cardiovascular complications during and following the episode. The goal of this study was to determine the usefulness of cardiovascular and inflammatory biomarkers for assessing the risk of early (within 30 days) or long-term (1-year follow-up) cardiovascular events.

Methods

A total of 730 hospitalized patients with CAP were prospectively followed up during 1 year. Cardiovascular (proadrenomedullin [proADM], pro-B-type natriuretic peptide (proBNP), proendothelin-1, and troponin T) and inflammatory (interleukin 6 [IL-6], C-reactive protein, and procalcitonin) biomarkers were measured on day 1, at day 4/5, and at day 30.

Results

Ninety-two patients developed an early event, and 67 developed a long-term event. Significantly higher initial levels of proADM, proendothelin-1, troponin, proBNP, and IL-6 were recorded in patients who developed cardiovascular events. Despite a decrease at day 4/5, levels remained steady until day 30 in those who developed late events. Biomarkers (days 1 and 30) independently predicted cardiovascular events adjusted for age, previous cardiac disease, Pao2/Fio2 < 250 mm Hg, and sepsis: ORs (95% CIs), proendothelin-1, 2.25 (1.34-3.79); proADM, 2.53 (1.53-4.20); proBNP, 2.67 (1.59-4.49); and troponin T, 2.70 (1.62-4.49) for early events. For late events, the ORs (95% CIs) were: proendothelin-1, 3.13 (1.41-7.80); proADM, 2.29 (1.01-5.19); and proBNP, 2.34 (1.01-5.56). Addition of IL-6 levels at day 30 to proendothelin-1 or proADM increased the ORs to 3.53 and 2.80, respectively.

Conclusions

Cardiac biomarkers are useful for identifying patients with CAP at high risk for early and long-term cardiovascular events. They may aid personalized treatment optimization and for designing future interventional studies to reduce cardiovascular risk.

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.

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    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].

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