Magnitude, Patterns, and Associated Predictors of Cardiovascular Events in Tetanus: A 2-Year, Single-Center, Ambidirectional Cohort Study Involving 572 Patients.

Autor: Pham OKN; Faculty of Infectious Diseases, School of Medicine, Vietnam National University, Ho Chi Minh City, Vietnam.; Viet Anh Department, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Tran BN; Faculty of Infectious Diseases, School of Medicine, Vietnam National University, Ho Chi Minh City, Vietnam., Duong MC; School of Population Health, University of New South Wales, Kensington, New South Wales, Australia., Do TCN; Viet Anh Department, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Pham TL; Emerging Infection Group, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam., Lam MY; Emerging Infection Group, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam., Thwaites L; Emerging Infection Group, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam., Nguyen VH; Department of Infectious Diseases, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2023 Sep 20; Vol. 10 (10), pp. ofad473. Date of Electronic Publication: 2023 Sep 20 (Print Publication: 2023).
DOI: 10.1093/ofid/ofad473
Abstrakt: Background: Cardiovascular events (CEs) remain the leading cause of death in patients with tetanus. We examined the incidence, patterns, and associated predictors of CEs among patients with tetanus in Vietnam.
Methods: An ambidirectional cohort study was conducted on hospitalized adult patients with tetanus at the Hospital for Tropical Diseases between 2019 and 2020. Information on demographics, tetanus disease, CEs and outcomes were collected.
Results: Among all 572 included patients, CEs accounted for 10.8% (95%CI 8.6-13.7%) and included Takotsubo cardiomyopathy (40.3%, 95%CI 29.0-52.8%), arrhythmia (19.4%, 95%CI 11.4-30.9%), sudden cardiac arrest (16.1%, 95%CI 9.0-27.2%), myocardial infarction (11.3%, 95%CI 5.6-21.5%), heart failure (6.5%, 95%CI 2.5-15.4%) and pulmonary embolism (6.5%, 95%CI 2.5-15.4%). CEs occurred from day 5 to 20 of illness. Among 62 CE patients, 21% (95%CI 12.7-32.6%) died and 61.3% (95%CI 48.9-72.4%) developed autonomic nervous system dysfunction (ANSD). Three-fourths (24/32) of patients with Takotsubo cardiomyopathy or myocardial infarction had ANSD. CEs were significantly associated with modified Ablett scores (AOR = 2.42, 95%CI 1.1-5.6, P = .04), underlying diseases (AOR = 2.7, 95%CI 1.1-6.8, P = .04) and overweight (AOR = 0.18, 95%CI .04-.8, P = .02).
Conclusions: CEs are not rare and associated with high mortality. The most common CE is Takotsubo cardiomyopathy. CEs can occur at any stage of illness, with or without ANSD. To prevent mortality, it is pivotal to screen CEs in patients with tetanus, especially those with underlying diseases, high modified Ablett scores, and a normal or low BMI. More studies are needed to fully elucidate the impact of ANSD on the cardiovascular function and the CE associated mortality in tetanus.
Competing Interests: Potential conflicts of interest. All authors: No reported conflicts of interest.
(© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze: MEDLINE
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