Host- and Pathogen-Related Factors for Acute Cardiac Events in Pneumococcal Pneumonia
| Autor: | Jordi Carratalà, Cristian Tebé, Aida González-Díaz, Alexander Rombauts, Carmen Ardanuy, Jordi Càmara, Enric Sastre-Escolà, Carlota Gudiol, Jordi Dorca, Gabriela Abelenda-Alonso, Natalia Pallares, Laia Lorenzo-Esteller |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
community-acquired pneumonia pneumococcal pneumonia Community-acquired pneumonia Heart diseases genotype 030204 cardiovascular system & hematology Pneumònia adquirida a la comunitat Major Articles Malalties del cor 03 medical and health sciences 0302 clinical medicine Internal medicine acute cardiac events medicine serotype 030212 general & internal medicine Myocardial infarction Prospective cohort study Septic shock business.industry Retrospective cohort study Odds ratio medicine.disease Pneumonia AcademicSubjects/MED00290 Infectious Diseases Oncology Pneumococcal pneumonia business |
| Zdroj: | Open Forum Infectious Diseases Dipòsit Digital de la UB Universidad de Barcelona |
| ISSN: | 2328-8957 |
| DOI: | 10.1093/ofid/ofaa522 |
| Popis: | Background Acute cardiac events (ACEs) are increasingly being recognized as a major complication in pneumococcal community-acquired pneumonia (CAP). Information regarding host- and pathogen-related factors for ACEs, including pneumococcal serotypes and clonal complexes, is scarce. Methods A retrospective study was conducted of a prospective cohort of patients hospitalized for CAP between 1996 and 2019. Logistic regression and funnel plot analyses were performed to determine host- and pathogen-related factors for ACEs. Results Of 1739 episodes of pneumococcal CAP, 1 or more ACEs occurred in 304 (17.5%) patients, the most frequent being arrhythmia (n = 207), heart failure (n = 135), and myocardial infarction (n = 23). The majority of ACEs (73.4%) occurred within 48 hours of admission. Factors independently associated with ACEs were older age, preexisting heart conditions, pneumococcal bacteremia, septic shock at admission, and high-risk pneumonia. Among 983 pneumococcal isolates, 872 (88.7%) were serotyped and 742 (75.5%) genotyped. The funnel plot analyses did not find any statistically significant association between serotypes or clonal complexes with ACEs. Nevertheless, there was a trend toward an association between CC230 and these complications. ACEs were independently associated with 30-day mortality (adjusted odds ratio, 1.88; 95% CI, 1.11–3.13). Conclusions ACEs are frequent in pneumococcal pneumonia and are associated with increased mortality. The risk factors defined in this study may help identify patients who must undergo close follow-up, including heart rhythm monitoring, and special care to avoid fluid overload, particularly during the first 48 hours of admission. These high-risk patients should be the target for preventive intervention strategies. |
| Databáze: | OpenAIRE |
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