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Lawrence H, McKeever TM, Lim WS. Readmission following hospital admission for community-acquired pneumonia in England. Thorax 2023; 78:1254-1261. [PMID: 37524392 DOI: 10.1136/thorax-2022-219925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/28/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Readmission rates following hospital admission with community-acquired pneumonia (CAP) have increased in the UK over the past decade. The aim of this work was to describe the cohort of patients with emergency 30-day readmission following hospitalisation for CAP in England and explore the reasons for this. METHODS A retrospective analysis of cases from the British Thoracic Society national adult CAP audit admitted to hospitals in England with CAP between 1 December 2018 and 31 January 2019 was performed. Cases were linked with corresponding patient level data from Hospital Episode statistics, providing data on the primary diagnosis treated during readmission and mortality. Analyses were performed describing the cohort of patients readmitted within 30 days, reasons for readmission and comparing those readmitted and primarily treated for pneumonia with other diagnoses. RESULTS Of 8136 cases who survived an index admission with CAP, 1304 (15.7%) were readmitted as an emergency within 30 days of discharge. The main problems treated on readmission were pneumonia in 516 (39.6%) patients and other respiratory disorders in 284 (21.8%). Readmission with pneumonia compared with all other diagnoses was associated with significant inpatient mortality (15.9% vs 6.5%; aOR 2.76, 95% CI 1.86 to 4.09, p<0.001). A diagnosis of hospital-acquired infection was more frequent in readmissions treated for pneumonia than other diagnoses (22.1% vs 3.9%, p<0.001). CONCLUSION Pneumonia is the most common condition treated on readmission following hospitalisation with CAP and carries a higher mortality than both the index admission or readmission due to other diagnoses. Strategies to reduce readmissions due to pneumonia are required.
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Affiliation(s)
- Hannah Lawrence
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Tricia M McKeever
- Academic Unit of Lifespan and Population Health, University of Nottingham, Nottingham, UK
- Nottingham Biomedical Research Centre, Nottingham, UK
| | - Wei Shen Lim
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Nottingham Biomedical Research Centre, Nottingham, UK
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2
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Affiliation(s)
- Thomas M File
- From the Division of Infectious Disease, Summa Health, Akron, and the Section of Infectious Disease, Northeast Ohio Medical University, Rootstown - both in Ohio (T.M.F.); and Norton Infectious Diseases Institute, Norton Healthcare, and the Division of Infectious Diseases, University of Louisville - both in Louisville, KY (J.A.R.)
| | - Julio A Ramirez
- From the Division of Infectious Disease, Summa Health, Akron, and the Section of Infectious Disease, Northeast Ohio Medical University, Rootstown - both in Ohio (T.M.F.); and Norton Infectious Diseases Institute, Norton Healthcare, and the Division of Infectious Diseases, University of Louisville - both in Louisville, KY (J.A.R.)
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3
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Rosende A, DiPette DJ, Martinez R, Brettler JW, Rodriguez G, Zuniga E, Ordunez P. HEARTS in the Americas clinical pathway. Strengthening the decision support system to improve hypertension and cardiovascular disease risk management in primary care settings. Front Cardiovasc Med 2023; 10:1102482. [PMID: 37180772 PMCID: PMC10169833 DOI: 10.3389/fcvm.2023.1102482] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/27/2023] [Indexed: 05/16/2023] Open
Abstract
Background HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative. It is implemented in 24 countries and over 2,000 primary healthcare facilities. This paper describes the results of a multicomponent, stepwise, quality improvement intervention designed by the HEARTS in the Americas to support advances in hypertension treatment protocols and evolution towards the Clinical Pathway. Methods The quality improvement intervention comprised: 1) the use of the appraisal checklist to evaluate the current hypertension treatment protocols, 2) a peer-to-peer review and consensus process to resolve discrepancies, 3) a proposal of a clinical pathway to be considered by the countries, and 4) a process of review, adopt/adapt, consensus and approval of the clinical pathway by the national HEARTS protocol committee. A year later, 16 participants countries (10 and 6 from each cohort, respectively) were included in a second evaluation using the HEARTS appraisal checklist. We used the median and interquartile scores range and the percentages of the maximum possible total score for each domain as a performance measure to compare the results pre and post-intervention. Results Among the eleven protocols from the ten countries in the first cohort, the baseline assessment achieved a median overall score of 22 points (ICR 18 -23.5; 65% yield). After the intervention, the overall score reached a median of 31.5 (ICR 28.5 -31.5; 93% yield). The second cohort of countries developed seven new clinical pathways with a median score of 31.5 (ICR 31.5 -32.5; 93% yield). The intervention was effective in three domains: 1. implementation (clinical follow-up intervals, frequency of drug refills, routine repeat blood pressure measurement when the first reading is off-target, and a straightforward course of action). 2. treatment (grouping all medications in a single daily intake and using a combination of two antihypertensive medications for all patients in the first treatment step upon the initial diagnosis of hypertension) and 3. management of cardiovascular risk (lower BP thresholds and targets based on CVD risk level, and the use of aspirin and statins in high-risk patients). Conclusion This study confirms that this intervention was feasible, acceptable, and instrumental in achieving progress in all countries and all three domains of improvement: implementation, blood pressure treatment, and cardiovascular risk management. It also highlights the challenges that prevent a more rapid expansion of HEARTS in the Americas and confirms that the main barriers are in the organization of health services: drug titration by non-physician health workers, the lack of long-acting antihypertensive medications, lack of availability of fixed-doses combination in a single pill and cannot use high-intensity statins in patients with established cardiovascular diseases. Adopting and implementing the HEARTS Clinical Pathway can improve the efficiency and effectiveness of hypertension and cardiovascular disease risk management programs.
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Affiliation(s)
- Andres Rosende
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States
| | - Donald J. DiPette
- School of Medicine Columbia, University of South Carolina, Columbia, SC, United States
| | - Ramon Martinez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States
| | - Jeffrey W. Brettler
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States
- Southern California Permanente Medical Group, Los Angeles, CA, United States
| | - Gonzalo Rodriguez
- Consultant for HEARTS in the Americas, PAHO/WHO Office in Argentina, Buenos Aires, Argentina
| | - Eric Zuniga
- Antofagasta Health Service, University of Antofagasta, Antofagasta, Chile
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States
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Crothers K, Nance RM, Whitney BM, Harding BN, Heckbert SR, Budoff MJ, Mathews WC, Bamford L, Cachay ER, Eron JJ, Napravnik S, Moore RD, Keruly JC, Willig A, Burkholder G, Feinstein MJ, Saag MS, Kitahata MM, Crane HM, Delaney JAC. Chronic obstructive pulmonary disease and the risk for myocardial infarction by type in people with HIV. AIDS 2023; 37:745-752. [PMID: 36728918 PMCID: PMC10041661 DOI: 10.1097/qad.0000000000003465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The relationship between chronic obstructive pulmonary disease (COPD) and cardiovascular disease in people with HIV (PWH) is incompletely understood. We determined whether COPD is associated with risk of myocardial infarction (MI) among PWH, and if this differs for type 1 (T1MI) and type 2 (T2MI). DESIGN We utilized data from five sites in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort, a multisite observational study. METHODS Our primary outcome was an adjudicated MI, classified as T1MI or T2MI. We defined COPD based on a validated algorithm requiring COPD diagnosis codes and at least 90-day continuous supply of inhalers. We conducted time-to-event analyses to first MI and used multivariable Cox proportional hazards models to measure associations between COPD and MI. RESULTS Among 12 046 PWH, 945 had COPD. Overall, 309 PWH had an MI: 58% had T1MI ( N = 178) and 42% T2MI ( N = 131). In adjusted models, COPD was associated with a significantly increased risk of all MI [adjusted hazard ratio (aHR) 2.68 (95% confidence interval (CI) 1.99-3.60)] even after including self-reported smoking [aHR 2.40 (95% CI 1.76-3.26)]. COPD was also associated with significantly increased risk of T1MI and T2MI individually, and with sepsis and non-sepsis causes of T2MI. Associations were generally minimally changed adjusting for substance use. CONCLUSION COPD is associated with a substantially increased risk for MI, including both T1MI and T2MI, among PWH. Given the association with both T1MI and T2MI, diverse mechanistic pathways are involved. Future strategies to decrease risk of T1MI and T2MI in PWH who have COPD are needed.
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Affiliation(s)
| | - Robin M Nance
- Department of Medicine
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | | | - Barbara N Harding
- Barcelona Institute of Global Health (ISGlobal) and Universitat Pompeu Fabra (UPF), Barcelona
- CIBER Epidemiolog ia y Salud Publica (CIBERESP), Madrid, Spain
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Matthew J Budoff
- Lundquist Institute at Harbor-University of California, Los Angeles (UCLA), Torrance
| | - William C Mathews
- Department of Medicine, University of California San Diego, California
| | - Laura Bamford
- Department of Medicine, University of California San Diego, California
| | - Edward R Cachay
- Department of Medicine, University of California San Diego, California
| | - Joseph J Eron
- University of North Carolina, Chapel Hill, North Carolina
| | | | - Richard D Moore
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jeanne C Keruly
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Amanda Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Greer Burkholder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Matthew J Feinstein
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Joseph A C Delaney
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
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Meregildo-Rodriguez ED, Asmat-Rubio MG, Rojas-Benites MJ, Vásquez-Tirado GA. Acute Coronary Syndrome, Stroke, and Mortality after Community-Acquired Pneumonia: Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12072577. [PMID: 37048661 PMCID: PMC10095577 DOI: 10.3390/jcm12072577] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/31/2023] Open
Abstract
One-third of adult inpatients with community-acquired pneumonia (CAP) develop acute coronary syndrome (ACS), stroke, heart failure (HF), arrhythmias, or die. The evidence linking CAP to cardiovascular disease (CVD) events is contradictory. We aimed to systematically review the role of CAP as a CVD risk factor. We registered the protocol (CRD42022352910) and searched for six databases from inception to 31 December 2022. We included 13 observational studies, 276,109 participants, 18,298 first ACS events, 12,421 first stroke events, 119 arrhythmic events, 75 episodes of new onset or worsening HF, 3379 deaths, and 218 incident CVD events. CAP increased the odds of ACS (OR 3.02; 95% CI 1.88–4.86), stroke (OR 2.88; 95% CI 2.09–3.96), mortality (OR 3.22; 95% CI 2.42–4.27), and all CVD events (OR 3.37; 95% CI 2.51–4.53). Heterogeneity was significant (I2 = 97%, p < 0.001). Subgroup analysis found differences according to the continent of origin of the study, the follow-up length, and the sample size (I2 > 40.0%, p < 0.10). CAP is a significant risk factor for all major CVD events including ACS, stroke, and mortality. However, these findings should be taken with caution due to the substantial heterogeneity and the possible publication bias.
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Stotts C, Corrales-Medina VF, Rayner KJ. Pneumonia-Induced Inflammation, Resolution and Cardiovascular Disease: Causes, Consequences and Clinical Opportunities. Circ Res 2023; 132:751-774. [PMID: 36927184 DOI: 10.1161/circresaha.122.321636] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Pneumonia is inflammation in the lungs, which is usually caused by an infection. The symptoms of pneumonia can vary from mild to life-threatening, where severe illness is often observed in vulnerable populations like children, older adults, and those with preexisting health conditions. Vaccines have greatly reduced the burden of some of the most common causes of pneumonia, and the use of antimicrobials has greatly improved the survival to this infection. However, pneumonia survivors do not return to their preinfection health trajectories but instead experience an accelerated health decline with an increased risk of cardiovascular disease. The mechanisms of this association are not well understood, but a persistent dysregulated inflammatory response post-pneumonia appears to play a central role. It is proposed that the inflammatory response during pneumonia is left unregulated and exacerbates atherosclerotic vascular disease, which ultimately leads to adverse cardiac events such as myocardial infarction. For this reason, there is a need to better understand the inflammatory cross talk between the lungs and the heart during and after pneumonia to develop therapeutics that focus on preventing pneumonia-associated cardiovascular events. This review will provide an overview of the known mechanisms of inflammation triggered during pneumonia and their relevance to the increased cardiovascular risk that follows this infection. We will also discuss opportunities for new clinical approaches leveraging strategies to promote inflammatory resolution pathways as a novel therapeutic target to reduce the risk of cardiac events post-pneumonia.
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Affiliation(s)
- Cameron Stotts
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (C.S., K.J.R).,Centre for Infection, Immunity, and Inflammation, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (C.S., V.F.C.-M.).,University of Ottawa Heart Institute, Ottawa, ON, Canada (C.S., K.J.R)
| | - Vicente F Corrales-Medina
- Centre for Infection, Immunity, and Inflammation, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (C.S., V.F.C.-M.).,Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (V.F.C-M).,Ottawa Hospital Research Institute, Ottawa, ON, Canada (V.F.C.-M)
| | - Katey J Rayner
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (C.S., K.J.R).,University of Ottawa Heart Institute, Ottawa, ON, Canada (C.S., K.J.R)
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7
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Nishimura N, Fukuda H. Risk of cardiovascular events leading to hospitalisation after Streptococcus pneumoniae infection: a retrospective cohort LIFE Study. BMJ Open 2022; 12:e059713. [PMID: 36332949 PMCID: PMC9639073 DOI: 10.1136/bmjopen-2021-059713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To elucidate the risk of cardiovascular event occurrence following Streptococcus pneumoniae infection. DESIGN Retrospective cohort study using a LIFE Study database. SETTING Three municipalities in Japan. PARTICIPANTS Municipality residents who were enrolled in either National Health Insurance or the Latter-Stage Elderly Healthcare System from April 2014 to March 2020. EXPOSURE Occurrence of S. pneumoniae infection. PRIMARY OUTCOME MEASURES Occurrence of one of the following cardiovascular events that led to hospitalisation after S. pneumoniae infection: (1) coronary heart disease (CHD), (2) heart failure (HF), (3) stroke or (4) atrial fibrillation (AF). RESULTS S. pneumoniae-infected patients were matched with non-infected patients for each cardiovascular event. We matched 209 infected patients and 43 499 non-infected patients for CHD, 179 infected patients and 44 148 non-infected patients for HF, 221 infected patients and 44 768 non-infected patients for stroke, and 241 infected patients and 39 568 non-infected patients for AF. During follow-up, the incidence rates for the matched infected and non-infected patients were, respectively, 38.6 (95% CI 19.9 to 67.3) and 30.4 (29.1 to 31.8) per 1000 person-years for CHD; 69.6 (41.9 to 108.8) and 50.5 (48.9 to 52.2) per 1000 person-years for HF; 75.4 (48.3 to 112.2) and 35.5 (34.1 to 36.9) per 1000 person-years for stroke; and 34.7 (17.9 to 60.6) and 11.2 (10.4 to 12.0) per 1000 person-years for AF. Infected patients were significantly more likely to develop stroke (adjusted HR: 2.05, 95% CI 1.22 to 3.47; adjusted subdistribution HR: 1.94, 95% CI 1.15 to 3.26) and AF (3.29, 1.49 to 7.26; 2.74, 1.24 to 6.05) than their non-infected counterparts. CONCLUSIONS S. pneumoniae infections elevate the risk of subsequent stroke and AF occurrence. These findings indicate that pneumococcal infections have short-term effects on patients' health and increase their midterm to long-term susceptibility to serious cardiovascular events.
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Affiliation(s)
- Naoaki Nishimura
- Department of Medicine, Kyushu University School of Medicine, Fukuoka, Japan
| | - Haruhisa Fukuda
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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Mansory EM, Abu-Farhaneh M, Iansavitchene A, Lazo-Langner A. Venous and Arterial Thrombosis in Ambulatory and Discharged COVID-19 Patients: A Systematic Review and Meta-analysis. TH OPEN 2022; 6:e276-e282. [PMID: 36299810 PMCID: PMC9484870 DOI: 10.1055/a-1913-4377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/25/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction
Venous and arterial thromboses are frequently observed complications in patients with severe novel coronavirus disease 2019 (COVID-19) infection who require hospital admission. In this study, we evaluate the epidemiology of venous and arterial thrombosis events in ambulatory and postdischarge patients with COVID-19 infection.
Materials and Method
EMBASE and MEDLINE were searched up to July 21, 2021, in addition to other sources. We included studies that assessed the epidemiology of venous and arterial thrombosis events in ambulatory and postdischarge COVID-19 patients.
Results
A total of 16 studies (102,779 patients) were identified. The overall proportion of venous thromboembolic events in all patients, that is, ambulatory and postdischarge, was 0.80% (95% confidence interval [CI]: 0.44–1.28), 0.28% (95% CI: 0.07–0.64), and 1.16% (95% CI: 0.69–1.74), respectively. Arterial events occurred in 0.75% (95% CI: 0.27–1.47) of all patients, 1.45% (95% CI: 1.10–1.86) of postdischarge patients, and 0.23% (95% CI: 0.019–0.66) of ambulatory patients. The pooled incidence rate estimates per 1,000 patient-days for VTE events were 0.06 (95% CI: 0.03–0.08) and 0.12 (95% CI: 0.07–0.19) for outpatients and postdischarge, respectively, whereas for arterial events were 0.10 (95% CI: 0–0.30) and 0.26 (95% CI: 0.16–0.37).
Conclusion
This study found a low risk of venous and arterial thrombi in ambulatory and postdischarge COVID-19 patients, with a higher risk in postdischarge patients compared with ambulatory patients. This suggests that regular universal thromboprophylaxis in these patient populations is probably not necessary.
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Affiliation(s)
- Eman M. Mansory
- Department of Medicine, Division of Hematology, Western University, London, Ontario, Canada
- Department of Hematology, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Alla Iansavitchene
- Health Sciences Library, London Health Sciences Centre, London, Ontario, Canada
| | - Alejandro Lazo-Langner
- Department of Medicine, Division of Hematology, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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9
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Søgaard M, Skjøth F, Nielsen PB, Smit J, Dalager-Pedersen M, Larsen TB, Lip GYH. Thromboembolic Risk in Patients With Pneumonia and New-Onset Atrial Fibrillation Not Receiving Anticoagulation Therapy. JAMA Netw Open 2022; 5:e2213945. [PMID: 35616941 PMCID: PMC9136621 DOI: 10.1001/jamanetworkopen.2022.13945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE New-onset atrial fibrillation (AF) is commonly reported in patients with severe infections. However, the absolute risk of thromboembolic events without anticoagulation remains unknown. OBJECTIVE To investigate the thromboembolic risks associated with AF in patients with pneumonia, assess the risk of recurrent AF, and examine the association of initiation of anticoagulation therapy with new-onset AF. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used linked Danish nationwide registries. Participants included patients hospitalized with incident community-acquired pneumonia in Denmark from 1998 to 2018. Statistical analysis was performed from August 15, 2021, to March 12, 2022. EXPOSURES New-onset AF. MAIN OUTCOMES AND MEASURES Thromboembolic events, recurrent AF, and all-cause death. Estimated risks were calculated for thromboembolism without anticoagulation therapy, new hospital or outpatient clinic contact with AF, initiation of anticoagulation therapy, and all-cause death at 1 and 3 years of follow-up. Death was treated as a competing risk, and inverse probability of censoring weights was used to account for patient censoring if they initiated anticoagulation therapy conditioned on AF. RESULTS Among 274 196 patients hospitalized for community-acquired pneumonia, 6553 patients (mean age [SD], 79.1 [11.0] years; 3405 women [52.0%]) developed new-onset AF. The 1-year risk of thromboembolism was 0.8% (95% CI, 0.8%-0.8%) in patients without AF vs 2.1% (95% CI, 1.8%-2.5%) in patients with new-onset AF without anticoagulation; this risk was 1.4% (95% CI, 1.0%-2.0%) among patients with AF with intermediate stroke risk and 2.8% (95% CI, 2.3%-3.4%) in patients with AF with high stroke risk. Three-year risks were 3.5% (95% CI, 2.8%-4.3%) among patients with intermediate stroke risk and 5.3% (95% CI, 4.4%-6.5%) among patients with high stroke risk. Among patients with new-onset AF, 32.9% (95% CI, 31.8%-34.1%) had a new hospital contact with AF, and 14.0% (95% CI, 13.2%-14.9%) initiated anticoagulation therapy during the 3 years after incident AF diagnosis. At 3 years, the all-cause mortality rate was 25.7% (95% CI, 25.6%-25.9%) in patients with pneumonia without AF vs 49.8% (95% CI, 48.6%-51.1%) in patients with new-onset AF. CONCLUSIONS AND RELEVANCE This cohort study found that new-onset AF after community-acquired pneumonia was associated with an increased risk of thromboembolism, which may warrant anticoagulation therapy. Approximately one-third of patients had a new hospital or outpatient clinic contact for AF during the 3-year follow-up, suggesting that AF triggered by acute infections is not a transient, self-terminating condition that reverses with resolution of the infection.
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Affiliation(s)
- Mette Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Flemming Skjøth
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
- Unit for Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Peter B. Nielsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Jesper Smit
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | | | - Torben B. Larsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Gregory Y. H. Lip
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
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10
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Liu WC, Li SB, Zhang CF, Cui XH. Severe pneumonia and acute myocardial infarction complicated with pericarditis after percutaneous coronary intervention: A case report. World J Clin Cases 2022; 10:3222-3231. [PMID: 35647136 PMCID: PMC9082686 DOI: 10.12998/wjcc.v10.i10.3222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/25/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cases of severe pneumonia complicated with acute myocardial infarction (AMI) with good prognosis after percutaneous coronary intervention (PCI) are rare, especially those with postoperative pericarditis and intestinal obstruction. CASE SUMMARY A 53-year-old male patient was admitted to the emergency department of our hospital because of paroxysmal chest tightness for 4 d, aggravated with chest pain for 12 h. The symptoms, electrocardiography, biochemical parameters, echocardiography and chest computed tomography confirmed the diagnosis of severe pneumonia complicated with AMI. The patient was treated with antiplatelet aggregation, anticoagulation, lipid regulation, vasodilation, anti-infective agents and direct PCI. The patient was discharged after 3 wk of treatment. Follow-up showed that the patient was asymptomatic without recurrence. CONCLUSION For patients with severe pneumonia complicated with AMI, PCI and antibiotic therapy is a life-saving strategy.
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Affiliation(s)
- Wei-Chao Liu
- The Third Ward of the Department of Cardiology, Baoding No. 1 Central Hospital, Baoding 071000, Hebei Province, China
| | - Shun-Bao Li
- The Third Ward of the Department of Cardiology, Baoding No. 1 Central Hospital, Baoding 071000, Hebei Province, China
| | - Chen-Feng Zhang
- The Third Ward of the Department of Cardiology, Baoding No. 1 Central Hospital, Baoding 071000, Hebei Province, China
| | - Xiang-Hui Cui
- The Third Ward of the Department of Cardiology, Baoding No. 1 Central Hospital, Baoding 071000, Hebei Province, China
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11
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Lee KY, Ho SW, Wang YH, Leong PY, Wei JCC. Risk of atrial fibrillation in patients with pneumonia. Heart Lung 2022; 52:110-116. [PMID: 34995914 DOI: 10.1016/j.hrtlng.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac arrhythmias have a strong association with pneumonia due to the cardiovascular response to infection. Electrocardiographic (ECG) changes in patients with pneumonia are associated with greater disease severity. Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. OBJECTIVE This population-based cohort study investigated the incidence of AF among Taiwanese adults with pneumonia using data from the National Health Insurance Research Database in Taiwan. METHODS A total of 34,883 patients with pneumonia and an equal number of individuals without pneumonia were eligible after excluding those with a previous diagnosis of AF and matching 1:1 by age, sex, and comorbidities. The Cox proportional hazards model was used to estimate hazard ratios for AF in both groups. RESULTS Patients were more likely to develop AF throughout the 1-year follow-up period after the diagnosis of pneumonia. The incidence of AF was 1.2 (414/334,746) per 1000 person-months. Patients with pneumonia had a 4.08-fold (95% confidence interval 3.37-4.95) increased risk for AF compared to patients without pneumonia. CONCLUSION Patients with pneumonia exhibited an increased risk for AF, especially in the early period after diagnosis of pneumonia.
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Affiliation(s)
- Kun-Yu Lee
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; Department of Emergency Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Sai-Wai Ho
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; Department of Emergency Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Pui-Ying Leong
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; Department of Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; PhD Program in Business, Feng Chia University, Taichung 407, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung 40402, Taiwan.
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12
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Li Z, Shao W, Zhang J, Ma J, Huang S, Yu P, Zhu W, Liu X. Prevalence of Atrial Fibrillation and Associated Mortality Among Hospitalized Patients With COVID-19: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8:720129. [PMID: 34722658 PMCID: PMC8548384 DOI: 10.3389/fcvm.2021.720129] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/15/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Epidemiological studies have shown that atrial fibrillation (AF) is a potential cardiovascular complication of coronavirus disease 2019 (COVID-19). We aimed to perform a systematic review and meta-analysis to clarify the prevalence and clinical impact of AF and new-onset AF in patients with COVID-19. Methods: PubMed, Embase, the Cochrane Library, and MedRxiv up to February 27, 2021, were searched to identify studies that reported the prevalence and clinical impact of AF and new-onset AF in patients with COVID-19. The study was registered with PROSPERO (CRD42021238423). Results: Nineteen eligible studies were included with a total of 21,653 hospitalized patients. The pooled prevalence of AF was 11% in patients with COVID-19. Older (≥60 years of age) patients with COVID-19 had a nearly 2.5-fold higher prevalence of AF than younger (<60 years of age) patients with COVID-19 (13 vs. 5%). Europeans had the highest prevalence of AF (15%), followed by Americans (11%), Asians (6%), and Africans (2%). The prevalence of AF in patients with severe COVID-19 was 6-fold higher than in patients with non-severe COVID-19 (19 vs. 3%). Furthermore, AF (OR: 2.98, 95% CI: 1.91 to 4.66) and new-onset AF (OR: 2.32, 95% CI: 1.60 to 3.37) were significantly associated with an increased risk of all-cause mortality among patients with COVID-19. Conclusion: AF is quite common among hospitalized patients with COVID-19, particularly among older (≥60 years of age) patients with COVID-19 and patients with severe COVID-19. Moreover, AF and new-onset AF were independently associated with an increased risk of all-cause mortality among hospitalized patients with COVID-19.
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Affiliation(s)
- Zuwei Li
- Cardiology Department, The Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, China
| | - Wen Shao
- Endocrine Department, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jing Zhang
- Anesthesiology Department, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianyong Ma
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Shanshan Huang
- Endocrine Department, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Peng Yu
- Endocrine Department, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wengen Zhu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao Liu
- Cardiology Department, The Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
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13
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Goyal P, Reshetnyak E, Khan S, Musse M, Navi BB, Kim J, Allen LA, Banerjee S, Elkind MSV, Shah SJ, Yancy C, Michos ED, Devereux RB, Okin PM, Weinsaft JW, Safford MM. Clinical Characteristics and Outcomes of Adults With a History of Heart Failure Hospitalized for COVID-19. Circ Heart Fail 2021; 14:e008354. [PMID: 34517720 DOI: 10.1161/circheartfailure.121.008354] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is important to understand the risk for in-hospital mortality of adults hospitalized with acute coronavirus disease 2019 (COVID-19) infection with a history of heart failure (HF). METHODS We examined patients hospitalized with COVID-19 infection from January 1, 2020 to July 22, 2020, from 88 centers across the US participating in the American Heart Association's COVID-19 Cardiovascular Disease registry. The primary exposure was history of HF and the primary outcome was in-hospital mortality. To examine the association between history of HF and in-hospital mortality, we conducted multivariable modified Poisson regression models that included sociodemographics and comorbid conditions. We also examined HF subtypes based on left ventricular ejection fraction in the prior year, when available. RESULTS Among 8920 patients hospitalized with COVID-19, mean age was 61.4±17.5 years and 55.5% were men. History of HF was present in 979 (11%) patients. In-hospital mortality occurred in 31.6% of patients with history of HF, and 16.9% in patients without a history of HF. In a fully adjusted model, history of HF was associated with increased risk for in-hospital mortality (relative risk: 1.16 [95% CI, 1.03-1.30]). Among 335 patients with left ventricular ejection fraction, heart failure with reduced ejection fraction was significantly associated with in-hospital mortality in a fully adjusted model (heart failure with reduced ejection fraction relative risk: 1.40 [95% CI, 1.10-1.79]; heart failure with mid-range ejection fraction relative risk: 1.06 [95% CI, 0.65-1.73]; heart failure with preserved ejection fraction relative risk, 1.06 [95% CI, 0.84-1.33]). CONCLUSIONS Risk for in-hospital mortality was substantial among adults with history of HF, in large part due to age and comorbid conditions. History of heart failure with reduced ejection fraction may confer especially elevated risk. This population thus merits prioritization for the COVID-19 vaccine.
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Affiliation(s)
- Parag Goyal
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
| | - Evgeniya Reshetnyak
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
| | - Sadiya Khan
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL (S.K., S.J.S., C.Y.)
| | - Mahad Musse
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
| | - Babak B Navi
- Department of Neurology, Feil Family Brain and Mind Research Institute (B.B.N.), Weill Cornell Medicine, New York, NY
| | - Jiwon Kim
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
| | - Larry A Allen
- Division of Cardiology, University of Colorado, Denver (L.A.A.)
| | - Samprit Banerjee
- Department of Population Science (S.B.), Weill Cornell Medicine, New York, NY
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL (S.K., S.J.S., C.Y.)
| | - Clyde Yancy
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL (S.K., S.J.S., C.Y.)
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (E.D.M.)
| | - Richard B Devereux
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
| | - Peter M Okin
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
| | - Jonathan W Weinsaft
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
| | - Monika M Safford
- Department of Medicine (P.G., E.R., M.M., J.K., R.B.D., P.M.O., J.W.W., M.M.S.), Weill Cornell Medicine, New York, NY
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14
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Wang BY, Lin FY, Ku MS, Wang YH, Lee KY, Ho SW. CHA2DS2-VASc Score for Major Adverse Cardiovascular Events Stratification in Patients with Pneumonia with and without Atrial Fibrillation. J Clin Med 2021; 10:jcm10184093. [PMID: 34575202 PMCID: PMC8466520 DOI: 10.3390/jcm10184093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Recent studies have shown an association between CHA2DS2-VASc (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke or transient ischemic attack (TIA), vascular disease, age 65 to 74 years, sex category) score and outcome of acute myocardial infarction, stroke, and chest pain. As pneumonia can affect the cardiovascular system, this study aimed to investigate the performance of the CHA2DS2-VASc score for major adverse cardiovascular events (MACEs) risk stratification in patients with pneumonia. METHODS A retrospective population-based cohort study including 61,843 patients with pneumonia. These patients were divided into two cohorts that were stratified based on the presence or absence of underlying atrial fibrillation (AF). We calculated the CHA2DS2-VASc score and incidence density rates of MACEs in each cohort. Cox regression was conducted to calculate hazard ratio of MACEs in pneumonia patients. The diagnostic performance of CHA2DS2-VASc with regard to MACEs was tested using the receiver operator characteristic curve. RESULTS Pneumonia patients with higher CHA2DS2-VASc score were more likely develop MACEs in both the AF and non-AF groups. In the AF group, the areas under the curve (AUC), sensitivity, and specificity were 0.824 (0.7773-0.8708), 0.7, and 0.84 respectively. In the non-AF group, the AUC, sensitivity, and specificity were 0.8185 (0.8152-0.8217), 0.75, and 0.83 respectively. CONCLUSIONS The CHA2DS2-VASc score showed good performance in the prediction of MACE in patients with pneumonia.
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Affiliation(s)
- Bo-Yuan Wang
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan; (B.-Y.W.); (K.-Y.L.)
- Department of Emergency Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Fei-Yi Lin
- Department of Nursing, Chung Shan Medical University Hospital, Taichung 402, Taiwan;
- Department of Nursing, Chung Shan Medical University, Taichung 402, Taiwan
| | - Min-Sho Ku
- Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 402, Taiwan;
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan;
| | - Kun-Yu Lee
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan; (B.-Y.W.); (K.-Y.L.)
- Department of Emergency Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Sai-Wai Ho
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan; (B.-Y.W.); (K.-Y.L.)
- Department of Emergency Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Correspondence: ; Tel.: +886-4-2473-9595 (ext. 32170)
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15
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Pak A, Adegboye OA, Eisen DP, McBryde ES. Hospitalisations related to lower respiratory tract infections in Northern Queensland. Aust N Z J Public Health 2021; 45:430-436. [PMID: 33900652 DOI: 10.1111/1753-6405.13104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/01/2020] [Accepted: 02/01/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To investigate the admission characteristics and hospital outcomes for patients admitted with lower respiratory tract infections (LRTI) in Northern Queensland. METHODS We perform a retrospective analysis of the data covering an 11-year period, 2006-2016. Length of hospital stay (LOS) is modelled by negative binomial regression and heterogeneous effects are checked using interaction terms. RESULTS A total of 11,726 patients were admitted due to LRTI; 2,430 (20.9%) were of Indigenous descent. We found higher hospitalisations due to LRTI for Indigenous than non-Indigenous patients, with a disproportionate increase in hospitalisations occurring during winter. The LOS for Indigenous patients was higher by 2.5 days [95%CI: -0.15; 5.05] than for non-Indigenous patients. The average marginal effect of 17.5 [95%CI: 15.3; 29.7] implies that the LOS for a patient, who was admitted to ICU, was higher by 17.5 days. CONCLUSIONS We highlighted the increased burden of LRTIs experienced by Indigenous populations, with this information potentially being useful for enhancing community-level policy making. Implications for public health: Future guidelines can use these results to make recommendations for preventative measures in Indigenous communities. Improvements in engagement and partnership with Indigenous communities and consumers can help increase healthcare uptake and reduce the burden of respiratory diseases.
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Affiliation(s)
- Anton Pak
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland
| | - Oyelola A Adegboye
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland.,Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland
| | - Damon P Eisen
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland.,College of Medicine and Dentistry, James Cook University, Queensland
| | - Emma S McBryde
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland
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16
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Clofent D, Álvarez A, Traversi L, Culebras M, Loor K, Polverino E. Comorbidities and mortality risk factors for patients with bronchiectasis. Expert Rev Respir Med 2021; 15:623-634. [PMID: 33583300 DOI: 10.1080/17476348.2021.1886084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Comorbidities in patients with bronchiectasis are common and have a significant impact on clinical outcomes, contributing to lower quality of life, lung function, and exacerbation frequency. At least 13 comorbidities have been associated with a higher risk of mortality in bronchiectasis patients. Nonetheless, the kind of relationship between bronchiectasis and comorbidities is heterogeneous and poorly understood.Areas covered: different biological mechanisms leading to bronchiectasis could have a role in the development of the associated comorbidities. Some comorbidities could have a causal relationship with bronchiectasis, possibly through a variable degree of systemic inflammation, such as in rheumatic disorders and bowel inflammatory diseases. Other comorbidities, such as COPD or asthma, could be associated through airway inflammation and there is an uncertain cause-effect relationship. Finally, shared risk factors could link different comorbidities to bronchiectasis such as in the case of cardiovascular diseases, where the known link between chronic systemic inflammation and pulmonary infection could play a significant role.Expert opinion: Although different tools have been developed to assess the role of comorbidities in bronchiectasis , we believe that the implementation of current strategies to manage them is absolutely necessary and could significantly improve long-term prognosis in patients with bronchiectasis.
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Affiliation(s)
- David Clofent
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Antonio Álvarez
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Letizia Traversi
- Department of Medicine and Surgery, Respiratory Diseases, Università dell'Insubria, Varese, Italy
| | - Mario Culebras
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Karina Loor
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Eva Polverino
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
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17
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Kang Y, Fang XY, Wang D, Wang XJ. Factors associated with acute myocardial infarction in older patients after hospitalization with community-acquired pneumonia: a cross-sectional study. BMC Geriatr 2021; 21:113. [PMID: 33563232 PMCID: PMC7871537 DOI: 10.1186/s12877-021-02056-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/31/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) and acute myocardial infarction cardiovascular (AMI) are two important health issues in older patients. Little is known regarding characteristics of AMI in older patients hospitalized for CAP. Therefore, we investigated the prevalence, characteristics compared with younger patients, impact on clinical outcomes and risk factors of AMI during hospitalization for CAP in geriatric patients. METHODS Eleven thousand nine adult inpatients consisted of 5111 patients≥65 years and 5898 patients< 65 years in respiratory ward diagnosed with CAP were retrospectively analyzed by electronic medical records. RESULTS 159 (3.1%) older patients in respiratory ward experienced AMI during hospitalization for CAP. AMI were more frequently seen in patients≥65 years compared with patients< 65 years (3.1% vs. 1.0%). Patients≥65 years who experienced AMI during hospitalization for CAP had higher percentage of respiratory failure (P = 0.001), hypertension (P = 0.008), dyspnea (P = 0.046), blood urea nitrogen (BUN) ≥7 mmol/L (P < 0.001), serum sodium< 130 mmol/L (P = 0.005) and had higher in-hospital mortality compared to patients< 65 years (10.1% vs. 6.6%). AMI was associated with increased in-hospital mortality (odds ratio, OR, with 95% confidence interval: 1.49 [1.24-1.82]; P < 0.01). Respiratory failure (OR, 1.34 [1.15-1.54]; P < 0.01), preexisting coronary artery disease (OR, 1.31[1.07-1.59]; P = 0.02), diabetes (OR, 1.26 [1.11-1.42]; P = 0.02) and BUN (OR, 1.23 [1.01-1.49]; P = 0.04) were correlated with the occurrence of AMI in the older patients after hospitalization with CAP. CONCLUSIONS The incidence of AMI during CAP hospitalization in geriatric patients is notable and have an impact on in-hospital mortality. Respiratory failure, preexisting coronary artery disease, diabetes and BUN was associated with the occurrence of AMI in the older patients after hospitalization with CAP. Particular attention should be paid to older patients with risk factors for AMI.
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Affiliation(s)
- Yu Kang
- Department of Geriatric Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Xiang-Yang Fang
- Department of Geriatric Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Dong Wang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Juan Wang
- Department of Geriatric Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
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18
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Vo VAD, Khalil MK, Al-Hasan MN. Risk and clinical outcomes of acute myocardial infarction and acute ischemic stroke following gram-negative bloodstream infection. INTERNATIONAL JOURNAL CARDIOLOGY HYPERTENSION 2021; 8:100079. [PMID: 33598654 PMCID: PMC7868809 DOI: 10.1016/j.ijchy.2021.100079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 10/26/2022]
Abstract
Objectives This retrospective cohort study examines incidence, risk factors, and clinical outcomes of acute myocardial infarction (AMI) and acute ischemic stroke (AIS) within one year of gram-negative bloodstream infection (GN-BSI) based on predefined clinical criteria. Methods Hospitalized adults with GN-BSI at Prisma Health-Midlands hospitals in South Carolina, USA from 2010 through 2015 were identified. Kaplan-Meier analysis was used to determine incidence of AMI and AIS within one year after GN-BSI. Multivariate Cox proportional hazards regression models were used to examine risk factors for AMI or AIS and impact on 1-year mortality. Results Among 1292 patients with GN-BSI, 263 and 17 developed AMI and AIS within 1-year with incidences of 23.4% and 1.9%, respectively. Majority of AMI were type 2 (164; 62%); 99 patients had type 1 AMI with incidence of 8.9%. Age >65 years (hazard ratio [HR] 1.52, 95% CI: 1.17-1.99), prior coronary artery disease or stroke (HR 1.74, 95% CI: 1.34-2.25), hypertension (HR 1.55, 95% CI: 1.13-2.15), end-stage renal disease (HR 1.52, 95% CI: 1.09-2.08), and quick Pitt bacteremia score (HR 1.55 per point, 95% CI: 1.40-1.72) were predictors of AMI/AIS. Development of type 1 AMI or AIS after GN-BSI was independently associated with increased 1-year mortality (HR 1.47, 95% CI: 1.03-2.07). Conclusions AMI and AIS occur frequently within one year of GN-BSI and have negative impact on 1-year survival. Future randomized clinical trials are needed to determine the most effective clinical interventions for prevention of AMI/AIS following BSI in high risk patients and improve survival after these events.
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Affiliation(s)
- Vinh-An D Vo
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Mazen K Khalil
- University of South Carolina School of Medicine, Columbia, SC, USA.,Department of Internal Medicine, Division of Cardiology, Prisma Health Midlands, Columbia, SC, USA
| | - Majdi N Al-Hasan
- University of South Carolina School of Medicine, Columbia, SC, USA.,Department of Internal Medicine, Division of Infectious Diseases, Prisma Health Midlands, Columbia, SC, USA
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19
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Zifodya JS, Duncan MS, So‐Armah KA, Attia EF, Akgün KM, Rodriguez‐Barradas MC, Marconi VC, Budoff MJ, Bedimo RJ, Alcorn CW, Soo Hoo GW, Butt AA, Kim JW, Sico JJ, Tindle HA, Huang L, Tate JP, Justice AC, Freiberg MS, Crothers K. Community-Acquired Pneumonia and Risk of Cardiovascular Events in People Living With HIV. J Am Heart Assoc 2020; 9:e017645. [PMID: 33222591 PMCID: PMC7763776 DOI: 10.1161/jaha.120.017645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 10/16/2020] [Indexed: 01/26/2023]
Abstract
Background Hospitalization with community-acquired pneumonia (CAP) is associated with an increased risk of cardiovascular disease (CVD) events in patients uninfected with HIV. We evaluated whether people living with HIV (PLWH) have a higher risk of CVD or mortality than individuals uninfected with HIV following hospitalization with CAP. Methods and Results We analyzed data from the Veterans Aging Cohort Study on US veterans admitted with their first episode of CAP from April 2003 through December 2014. We used Cox regression analyses to determine whether HIV status was associated with incident CVD events and mortality from date of admission through 30 days after discharge (30-day mortality), adjusting for known CVD risk factors. We included 4384 patients (67% [n=2951] PLWH). PLWH admitted with CAP were younger, had less severe CAP, and had fewer CVD risk factors than patients with CAP who were uninfected with HIV. In multivariable-adjusted analyses, CVD risk was similar in PLWH compared with HIV-uninfected (hazard ratio [HR], 0.89; 95% CI, 0.70-1.12), but HIV infection was associated with higher mortality risk (HR, 1.49; 95% CI, 1.16-1.90). In models stratified by HIV status, CAP severity was significantly associated with incident CVD and 30-day mortality in PLWH and patients uninfected with HIV. Conclusions In this study, the risk of CVD events during or after hospitalization for CAP was similar in PLWH and patients uninfected with HIV, after adjusting for known CVD risk factors and CAP severity. HIV infection, however, was associated with increased 30-day mortality after CAP hospitalization in multivariable-adjusted models. PLWH should be included in future studies evaluating mechanisms and prevention of CVD events after CAP.
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Affiliation(s)
- Jerry S. Zifodya
- Department of MedicineSection of Pulmonary Diseases, Critical Care, and Environmental MedicineTulane University School of MedicineNew OrleansLA
| | - Meredith S. Duncan
- Department of MedicineDivision of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTN
- Department of BiostatisticsCollege of Public HealthUniversity of KentuckyLexingtonKY
| | - Kaku A. So‐Armah
- Section of General Internal MedicineBoston University School of MedicineBostonMA
| | - Engi F. Attia
- Department of MedicineDivision of Pulmonary, Critical Care, and Sleep MedicineUniversity of WashingtonSeattleWA
| | - Kathleen M. Akgün
- Department of MedicineSection of Pulmonary, Critical Care and Sleep MedicineVeterans Affairs Connecticut Healthcare SystemWest HavenCT
- Yale University School of MedicineNew HavenCT
| | - Maria C. Rodriguez‐Barradas
- Infectious Diseases SectionMichael E. DeBakey Veterans Affairs Medical CenterBaylor College of MedicineHoustonTX
| | - Vincent C. Marconi
- Atlanta Veterans Affairs Medical CenterDivision of Infectious DiseasesDepartment of Global HealthRollins School of Public Health and Department of MedicineEmory University School of MedicineAtlantaGA
| | - Matthew J. Budoff
- Department of CardiologyLos Angeles Biomedical Research Institute at Harbor‐UCLALos AngelesCA
| | - Roger J. Bedimo
- Department of MedicineVA North Texas Health Care System and University of Texas Southwestern Medical CenterDallasTX
| | - Charles W. Alcorn
- Department of BiostatisticsGraduate School of Public HealthUniversity of PittsburghPA
| | - Guy W. Soo Hoo
- Department of MedicinePulmonary, Critical Care and Sleep SectionVeterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCA
| | - Adeel A. Butt
- Veterans AffairsPittsburgh Healthcare SystemPittsburghPA
- Weill Cornell Medical CollegeNew YorkNY
- Weill Cornell Medical CollegeDohaQatar
| | - Joon W. Kim
- Critical Care MedicineJames J. Peters Veterans Affairs Medical CenterBronxNY
| | - Jason J. Sico
- Neurology Service and Clinical Epidemiology Research Center (CERC)Veterans Affairs Connecticut Healthcare SystemWest HavenCT
- Departments of Internal MedicineSection of Internal Medicine, NeurologySections of Vascular Neurology and General NeurologyCenter for NeuroEpidemiological and Clinical ResearchYale School of MedicineNew HavenCT
| | - Hilary A. Tindle
- Geriatric Research Education and Clinical Centers (GRECC)Veterans Affairs Tennessee Valley Healthcare SystemNashvilleTN
- Department of MedicineDivision of General Internal Medicine and Public HealthVanderbilt University Medical CenterNashvilleTN
| | - Laurence Huang
- Department of MedicineZuckerberg San Francisco General HospitalUniversity of California San FranciscoSan FranciscoCA
| | - Janet P. Tate
- Department of MedicineSection of Pulmonary, Critical Care and Sleep MedicineVeterans Affairs Connecticut Healthcare SystemWest HavenCT
- Yale University School of MedicineNew HavenCT
| | - Amy C. Justice
- Yale University School of MedicineNew HavenCT
- Department of MedicineVeterans Affairs Connecticut Healthcare SystemWest HavenCT
| | - Matthew S. Freiberg
- Department of MedicineDivision of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTN
- Department of MedicineDivision of General Internal Medicine and Public HealthVanderbilt University Medical CenterNashvilleTN
| | - Kristina Crothers
- Department of MedicineDivision of Pulmonary, Critical Care, and Sleep MedicineUniversity of WashingtonSeattleWA
- Veterans Affairs Puget Sound Health Care SystemSeattleWA
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20
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Infection as a Trigger for Cardiovascular Disease. Am J Med 2020; 133:1372-1373. [PMID: 32649935 PMCID: PMC7340018 DOI: 10.1016/j.amjmed.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/01/2022]
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21
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Putot A, Bouhey E, Tetu J, Barben J, Timsit E, Putot S, Ray P, Manckoundia P. Troponin Elevation in Older Patients with Acute Pneumonia: Frequency and Prognostic Value. J Clin Med 2020; 9:E3623. [PMID: 33182841 PMCID: PMC7696095 DOI: 10.3390/jcm9113623] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/27/2020] [Accepted: 11/10/2020] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular (CV) events are particularly frequent after acute pneumonia (AP) in the elderly. We aimed to assess whether cardiac troponin I, a specific biomarker of myocardial injury, independently predicts CV events and death after AP in older inpatients. Among 214 consecutive patients with AP aged ≥75 years admitted to a university hospital, 171 with a cardiac troponin I sample in the 72 h following diagnosis of AP were included, and 71 (42%) were found to have myocardial injury (troponin > 100 ng/L). Patients with and without myocardial injury were similar in terms of age, gender and comorbidities, but those with myocardial injury had more severe clinical presentation (median (interquartile range) Pneumonia Severity Index: 60 (40-95) vs. 45 (30-70), p = 0.003). Myocardial injury was strongly associated with in-hospital myocardial infarction (25% vs. 0%, p < 0.001), CV mortality (11 vs. 1%, p = 0.003) and all-cause mortality (34 vs. 13%, p = 0.002). After adjustment for confounders, myocardial injury remained a strong predictive factor of in-hospital mortality (odds ratio (95% confidence interval): 3.32 (1.42-7.73), p = 0.005) but not one-year mortality (1.61 (0.77-3.35), p = 0.2). Cardiac troponin I elevation, a specific biomarker of myocardial injury, was found in nearly half of an unselected cohort of older inpatients with AP and was associated with a threefold risk of in-hospital death.
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Affiliation(s)
- Alain Putot
- Geriatrics Internal Medicine Department, Centre Hospitalier Universitaire Dijon Bourgogne, 21000 Dijon, France; (J.B.); (S.P.); (P.M.)
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, Université Bourgogne Franche Comté, 21000 Dijon, France
| | - Emmanuel Bouhey
- Emergency Department, Centre Hospitalier Universitaire Dijon Bourgogne, 21000 Dijon, France; (E.B.); (E.T.); (P.R.)
| | - Jennifer Tetu
- Microbiology Department, Centre Hospitalier Universitaire Dijon Bourgogne, 21000 Dijon, France;
| | - Jérémy Barben
- Geriatrics Internal Medicine Department, Centre Hospitalier Universitaire Dijon Bourgogne, 21000 Dijon, France; (J.B.); (S.P.); (P.M.)
| | - Eléonore Timsit
- Emergency Department, Centre Hospitalier Universitaire Dijon Bourgogne, 21000 Dijon, France; (E.B.); (E.T.); (P.R.)
| | - Sophie Putot
- Geriatrics Internal Medicine Department, Centre Hospitalier Universitaire Dijon Bourgogne, 21000 Dijon, France; (J.B.); (S.P.); (P.M.)
| | - Patrick Ray
- Emergency Department, Centre Hospitalier Universitaire Dijon Bourgogne, 21000 Dijon, France; (E.B.); (E.T.); (P.R.)
| | - Patrick Manckoundia
- Geriatrics Internal Medicine Department, Centre Hospitalier Universitaire Dijon Bourgogne, 21000 Dijon, France; (J.B.); (S.P.); (P.M.)
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22
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Jones B, Waterer G. Advances in community-acquired pneumonia. Ther Adv Infect Dis 2020; 7:2049936120969607. [PMID: 33224494 PMCID: PMC7656869 DOI: 10.1177/2049936120969607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/07/2020] [Indexed: 12/24/2022] Open
Abstract
Community-acquired pneumonia is one of the commonest and deadliest of the infectious diseases, yet our understanding of it remains relatively poor. The recently published American Thoracic Society and Infectious Diseases Society of America Community-acquired pneumonia guidelines acknowledged that most of what we accept as standard of care is supported only by low quality evidence, highlighting persistent uncertainty and deficiencies in our knowledge. However, progress in diagnostics, translational research, and epidemiology has changed our concept of pneumonia, contributing to a gradual improvement in prevention, diagnosis, treatment, and outcomes for our patients. The emergence of considerable evidence about adverse long-term health outcomes in pneumonia survivors has also challenged our concept of pneumonia as an acute disease and what treatment end points are important. This review focuses on advances in the research and care of community-acquired pneumonia in the past two decades. We summarize the evidence around our understanding of pathogenesis and diagnosis, discuss key contentious management issues including the role of procalcitonin and the use or non-use of corticosteroids, and explore the relationships between pneumonia and long-term outcomes including cardiovascular and cognitive health.
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Affiliation(s)
- Barbara Jones
- Division of Pulmonary and Critical Care, University of Utah and Salt Lake City VA Healthcare System, Salt Lake City, UT, USA
| | - Grant Waterer
- University of Western Australia, Royal Perth Hospital, Perth, WA 6009, Australia
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23
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Rombauts A, Abelenda-Alonso G, Càmara J, Lorenzo-Esteller L, González-Díaz A, Sastre-Escolà E, Gudiol C, Dorca J, Tebé C, Pallarès N, Ardanuy C, Carratalà J. Host- and Pathogen-Related Factors for Acute Cardiac Events in Pneumococcal Pneumonia. Open Forum Infect Dis 2020; 7:ofaa522. [PMID: 33335932 PMCID: PMC7727332 DOI: 10.1093/ofid/ofaa522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Alexander Rombauts
- Department of Infectious Diseases, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Gabriela Abelenda-Alonso
- Department of Infectious Diseases, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Càmara
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain.,Department of Microbiology, Bellvitge Universtiy Hospital, Hospitalet de Llobregat, Barcelona, Spain.,Research Network for Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Laia Lorenzo-Esteller
- Department of Infectious Diseases, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Aida González-Díaz
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain.,Department of Microbiology, Bellvitge Universtiy Hospital, Hospitalet de Llobregat, Barcelona, Spain.,Research Network for Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Enric Sastre-Escolà
- Department of Infectious Diseases, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Carlota Gudiol
- Department of Infectious Diseases, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain.,University of Barcelona, Barcelona, Spain
| | - Jordi Dorca
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Department of Pneumology, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Cristian Tebé
- Biostatistics Unit at Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Natàlia Pallarès
- Biostatistics Unit at Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Carmen Ardanuy
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain.,Department of Microbiology, Bellvitge Universtiy Hospital, Hospitalet de Llobregat, Barcelona, Spain.,Research Network for Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,University of Barcelona, Barcelona, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain.,University of Barcelona, Barcelona, Spain
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24
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Marra F, Zhang A, Gillman E, Bessai K, Parhar K, Vadlamudi NK. The protective effect of pneumococcal vaccination on cardiovascular disease in adults: A systematic review and meta-analysis. Int J Infect Dis 2020; 99:204-213. [PMID: 32735953 DOI: 10.1016/j.ijid.2020.07.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/13/2020] [Accepted: 07/21/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Epidemiological studies suggest that there is a link between pneumococcal infection and adverse cardiovascular outcomes such as myocardial infarction. Multiple studies have evaluated the protective effect of the 23-valent polysaccharide pneumococcal vaccination (PPV23), but results have varied. Therefore, a meta-analysis was conducted to summarize available evidence on the impact of PPV23 on cardiovascular disease. METHODS A literature search from January 1946 to September 2019 was conducted across Embase, Medline and Cochrane. All studies were included that evaluated PPV23 compared with a control (placebo, no vaccine or another vaccine) for any cardiovascular events, including: myocardial infarction (MI), heart failure and cerebrovascular events. Risk ratios (RRs) were pooled using random effects models. RESULTS Eighteen studies were included, with a total of 716,108 participants. Vaccination with PPV23 was associated with decreased risk of any cardiovascular event (RR: 0.91; 95% CI: 0.84-0.99), and MI (RR: 0.88; 95% CI: 0.79-0.98) in all age groups, with a significant effect in those aged ≥65 years, but not in the younger age group. Similarly, PPV23 vaccine was associated with significant risk reduction in all-cause mortality in all ages (RR: 0.78; 95% CI: 0.68-0.88), specifically in those aged ≥65 years (RR: 0.71; 95% CI: 0.60-0.84). A significant risk reduction in cerebrovascular disease was not observed following pneumococcal vaccination. CONCLUSIONS Polysaccharide pneumococcal vaccination decreased the risk for some adverse cardiovascular events, specifically acute MI in the vaccinated population, particularly for those individuals aged ≥65 years. It would be highly beneficial to vaccinate the population who is at greater risk of cardiovascular diseases.
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Affiliation(s)
- Fawziah Marra
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada.
| | - Angel Zhang
- Faculty of Sciences, The University of British Columbia, Vancouver, Canada
| | - Emma Gillman
- Faculty of Sciences, The University of British Columbia, Vancouver, Canada
| | - Katherine Bessai
- Faculty of Sciences, The University of British Columbia, Vancouver, Canada
| | - Kamalpreet Parhar
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
| | - Nirma Khatri Vadlamudi
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
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25
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Dobler CC, Hakim M, Singh S, Jennings M, Waterer G, Garden FL. Ability of the LACE index to predict 30-day hospital readmissions in patients with community-acquired pneumonia. ERJ Open Res 2020; 6:00301-2019. [PMID: 32714954 PMCID: PMC7369430 DOI: 10.1183/23120541.00301-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 05/05/2020] [Indexed: 11/13/2022] Open
Abstract
Background and objective Hospital readmissions within 30 days are used as an indicator of quality of hospital care. We aimed to evaluate the ability of the LACE (Length of stay, Acuity of admission, Comorbidities based on Charlson comorbidity score and number of Emergency visits in the last 6 months) index to predict the risk of 30-day readmissions in patients hospitalised for community-acquired pneumonia (CAP). Methods In this retrospective cohort study a LACE index score was calculated for patients with a principal diagnosis of CAP admitted to a tertiary hospital in Sydney, Australia. The predictive ability of the LACE score for 30-day readmissions was assessed using receiver operator characteristic curves with C-statistic. Results Of 3996 patients admitted to hospital for CAP at least once, 8.0% (n=327) died in hospital and 14.6% (n=584) were readmitted within 30 days. 17.8% (113 of 636) of all 30-day readmissions were again due to CAP, followed by readmissions for chronic obstructive pulmonary disease, heart failure and chest pain. The LACE index had moderate discriminative ability to predict 30-day readmission (C-statistic=0.6395) but performed poorly for the prediction of 30-day readmissions due to CAP (C-statistic=0.5760). Conclusions The ability of the LACE index to predict all-cause 30-day hospital readmissions is comparable to more complex pneumonia-specific indices with moderate discrimination. For the prediction of 30-day readmissions due to CAP, the performance of the LACE index and modified risk prediction models using readily available variables (sex, age, specific comorbidities, after-hours, weekend, winter or summer admission) is insufficient. The LACE index is easy to use and its ability to predict all-cause 30-day hospital readmissions for patients hospitalised with community-acquired pneumonia is comparable to more complex pneumonia-specific indices with moderate discriminationhttps://bit.ly/2SYkxam
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Affiliation(s)
- Claudia C Dobler
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia.,Dept of Respiratory Medicine, Liverpool Hospital, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Maryam Hakim
- Dept of Respiratory Medicine, Liverpool Hospital, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Sidhartha Singh
- Dept of Respiratory Medicine, Liverpool Hospital, Sydney, Australia
| | | | | | - Frances L Garden
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
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26
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Tralhão A, Póvoa P. Cardiovascular Events After Community-Acquired Pneumonia: A Global Perspective with Systematic Review and Meta-Analysis of Observational Studies. J Clin Med 2020; 9:E414. [PMID: 32028660 PMCID: PMC7073946 DOI: 10.3390/jcm9020414] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 12/12/2022] Open
Abstract
Acute cardiovascular disease after community-acquired pneumonia is a well-accepted complication for which definitive treatment strategies are lacking. These complications share some common features but have distinct diagnostic and treatment approaches. We therefore undertook an updated systematic review and meta-analysis of observational studies reporting the incidence of overall complications, acute coronary syndromes, new or worsening heart failure, new or worsening arrhythmias and acute stroke, as well as short-term mortality outcomes. To set a framework for future research, we further included a holistic review of the interplay between the two conditions. From 1984 to 2019, thirty-nine studies were accrued, involving 92,188 patients, divided by setting (inpatients versus outpatients) and clinical severity (low risk versus high risk). Overall cardiac complications occurred in 13.9% (95% confidence interval (CI) 9.6-18.9), acute coronary syndromes in 4.5% (95% CI 2.9-6.5), heart failure in 9.2% (95% CI 6.7-12.2), arrhythmias in 7.2% (95% CI 5.6-9.0) and stroke in 0.71% (95% CI 0.1-3.9) of pooled inpatients. During this period, meta-regression analysis suggests that the incidence of overall and individual cardiac complications is decreasing. After adjusting for confounders, cardiovascular events taking place after community-acquired pneumonia independently increase the risk for short-term mortality (range of odds-ratio: 1.39-5.49). These findings highlight the need for effective, large trial based, preventive and therapeutic interventions in this important patient population.
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Affiliation(s)
- António Tralhão
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005 Lisbon, Portugal;
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Avenida Professor Doutor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Pedro Póvoa
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005 Lisbon, Portugal;
- NOVA Medical School, CHRH, New University of Lisbon, 1069-056 Lisbon, Portugal
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, DK-5000 Odense C, Denmark
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28
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Severiche-Bueno D, Parra-Tanoux D, Reyes LF, Waterer GW. Hot topics and current controversies in community-acquired pneumonia. Breathe (Sheff) 2019; 15:216-225. [PMID: 31508159 PMCID: PMC6717612 DOI: 10.1183/20734735.0205-2019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Community-acquired pneumonia (CAP) is one of the most common infectious diseases, as well as a major cause of death both in developed and developing countries, and it remains a challenge for physicians around the world. Several guidelines have been published to guide clinicians in how to diagnose and take care of patients with CAP. However, there are still many areas of debate and uncertainty where research is needed to advance patient care and improve clinical outcomes. In this review we highlight current hot topics in CAP and present updated evidence around these areas of controversy. Community-acquired pneumonia is the most frequent cause of infectious death worldwide; however, there are several areas of controversy that should be addressed to improve patient care. This review presents the available data on these topics.http://bit.ly/2ShnH7A
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Affiliation(s)
- Diego Severiche-Bueno
- Infectious Diseases and Critical Care Depts, Universidad de La Sabana, Chía, Colombia
| | - Daniela Parra-Tanoux
- Infectious Diseases and Critical Care Depts, Universidad de La Sabana, Chía, Colombia
| | - Luis F Reyes
- Infectious Diseases and Critical Care Depts, Universidad de La Sabana, Chía, Colombia
| | - Grant W Waterer
- Royal Perth Bentley Hospital Group, University of Western Australia, Perth, Australia
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29
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Li L, Binney LE, Carter S, Gutnikov SA, Beebe S, Bowsher-Brown K, Silver LE, Rothwell PM. Sensitivity of Administrative Coding in Identifying Inpatient Acute Strokes Complicating Procedures or Other Diseases in UK Hospitals. J Am Heart Assoc 2019; 8:e012995. [PMID: 31266385 PMCID: PMC6662118 DOI: 10.1161/jaha.119.012995] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Administrative hospital diagnostic coding data are increasingly used in “big data” research and to assess complication rates after surgery or acute medical conditions. Acute stroke is a common complication of several procedures/conditions, such as carotid interventions, but data are lacking on the sensitivity of administrative coding in identifying acute stroke during inpatient stay. Methods and Results Using all acute strokes ascertained in a population‐based cohort (2002–2017) as the reference, we determined the sensitivity of hospital administrative diagnostic codes (International Classification of Diseases, Tenth Revision; ICD‐10) for identifying acute strokes that occurred during hospital admission for other reasons, stratified by coding strategies, study periods, and stroke severity (National Institutes of Health Stroke Score</≥5). Of 3011 acute strokes, 198 (6.6%) occurred during hospital admissions for procedures/other diseases, including 122 (61.6%) major strokes. Using stroke‐specific codes (ICD‐10=I60–I61 and I63–I64) in the primary diagnostic position, 66 of the 198 cases were correctly identified (sensitivity for any stroke, 33.3%; 95% CI, 27.1–40.2; minor stroke, 30.3%; 95% CI, 21.0–41.5; major stroke, 35.2%; 95% CI, 27.2–44.2), with no improvement of sensitivity over time (Ptrend=0.54). Sensitivity was lower during admissions for surgery/procedures than for other acute medical admissions (n/% 17/23.3% versus 49/39.2%; P=0.02). Sensitivity improved to 60.6% (53.6–67.2) for all and 61.6% (50.0–72.1) for surgery/procedures if other diagnostic positions were used, and to 65.2% (58.2–71.5) and 68.5% (56.9–78.1) respectively if combined with use of all possible nonspecific stroke‐related codes (ie, adding ICD‐10=I62 and I65–I68). Conclusions Low sensitivity of administrative coding in identifying acute strokes that occurred during admission does not support its use alone for audit of complication rates of procedures or hospitalization for other reasons.
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Affiliation(s)
- Linxin Li
- 1 Centre for Prevention of Stroke and Dementia Nuffield Department of Clinical Neuroscience University of Oxford United Kingdom
| | - Lucy E Binney
- 1 Centre for Prevention of Stroke and Dementia Nuffield Department of Clinical Neuroscience University of Oxford United Kingdom
| | - Samantha Carter
- 1 Centre for Prevention of Stroke and Dementia Nuffield Department of Clinical Neuroscience University of Oxford United Kingdom
| | - Sergei A Gutnikov
- 1 Centre for Prevention of Stroke and Dementia Nuffield Department of Clinical Neuroscience University of Oxford United Kingdom
| | - Sally Beebe
- 1 Centre for Prevention of Stroke and Dementia Nuffield Department of Clinical Neuroscience University of Oxford United Kingdom
| | - Karen Bowsher-Brown
- 1 Centre for Prevention of Stroke and Dementia Nuffield Department of Clinical Neuroscience University of Oxford United Kingdom
| | - Louise E Silver
- 1 Centre for Prevention of Stroke and Dementia Nuffield Department of Clinical Neuroscience University of Oxford United Kingdom
| | - Peter M Rothwell
- 1 Centre for Prevention of Stroke and Dementia Nuffield Department of Clinical Neuroscience University of Oxford United Kingdom
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30
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Waterer GW, Self WH, Courtney DM, Grijalva CG, Balk RA, Girard TD, Fakhran SS, Trabue C, McNabb P, Anderson EJ, Williams DJ, Bramley AM, Jain S, Edwards KM, Wunderink RG. In-Hospital Deaths Among Adults With Community-Acquired Pneumonia. Chest 2018; 154:628-635. [PMID: 29859184 DOI: 10.1016/j.chest.2018.05.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/10/2018] [Accepted: 05/01/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Adults hospitalized with community-acquired pneumonia (CAP) are at high risk for short-term mortality. However, it is unclear whether improvements in in-hospital pneumonia care could substantially lower this risk. We extensively reviewed all in-hospital deaths in a large prospective CAP study to assess the cause of each death and assess the extent of potentially preventable mortality. METHODS We enrolled adults hospitalized with CAP at five tertiary-care hospitals in the United States. Five physician investigators reviewed the medical record and study database for each patient who died to identify the cause of death, the contribution of CAP to death, and any preventable factors potentially contributing to death. RESULTS Among 2,320 enrolled patients, 52 (2.2%) died during initial hospitalization. Among these 52 patients, 33 (63.4%) were ≥ 65 years old, and 32 (61.5%) had ≥ two chronic comorbidities. CAP was judged to be the direct cause of death in 27 patients (51.9%). Ten patients (19.2%) had do-not-resuscitate orders prior to admission. Four patients were identified in whom a lapse in quality of care potentially contributed to death; preexisting end-of-life limitations were present in two of these patients. Two patients seeking full medical care experienced a lapse in in-hospital quality of pneumonia care that potentially contributed to death. CONCLUSIONS In this study of adults with CAP at tertiary-care hospitals with a low mortality rate, most in-hospital deaths did not appear to be preventable with improvements in in-hospital pneumonia care. Preexisting end-of-life limitations in care, advanced age, and high comorbidity burden were common among those who died.
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Affiliation(s)
- Grant W Waterer
- University of Western Australia, Perth, WA, Australia; Northwestern University Feinberg School of Medicine, Chicago, IL.
| | | | - D Mark Courtney
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | - Christopher Trabue
- University of Tennessee Health Science Center/Saint Thomas Health, Nashville, TN
| | - Paul McNabb
- University of Tennessee Health Science Center/Saint Thomas Health, Nashville, TN
| | | | | | | | - Seema Jain
- Centers for Disease Control and Prevention, Atlanta, GA
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31
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Polgreen LA, Riedle BN, Cavanaugh JE, Girotra S, London B, Schroeder MC, Polgreen PM. Estimated Cardiac Risk Associated With Macrolides and Fluoroquinolones Decreases Substantially When Adjusting for Patient Characteristics and Comorbidities. J Am Heart Assoc 2018; 7:e008074. [PMID: 29680825 PMCID: PMC6015293 DOI: 10.1161/jaha.117.008074] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/22/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Some studies have found that antimicrobials, especially macrolides, increase the risk of cardiovascular death. We investigated potential cardiac-related events associated with antimicrobial use in a population of patients with acute myocardial infarction. METHODS AND RESULTS For 185 010 Medicare beneficiaries, we recorded prescriptions for azithromycin, clarithromycin, levofloxacin, moxifloxacin, doxycycline, and amoxicillin-clavulanate. In the following week, we recorded death, acute myocardial infarction, atrial fibrillation or atrial flutter, a non-atrial fibrillation/atrial flutter arrhythmia, or ventricular arrhythmia. We fit unadjusted and adjusted logistic regression models using generalized estimating equations. Adjusted models included patients' comorbidities, medications, procedures, demographics, insurance status, time since index acute myocardial infarction, number of visits, and the influenza rate. In unadjusted analyses, macrolides and fluoroquinolones were associated with a risk of cardiac events. However, the risk associated with macrolide use was substantially attenuated after adjustment for a wide range of variables, and the risk associated with fluoroquinolones was no longer statistically significant. For example, for azithromycin, the odds ratio for any cardiac event or death was 1.35 (95% confidence interval, 1.27-1.44; P<0.0001), but after controlling for a wide range of covariates, the odds ratio decreased to 1.01 (95% confidence interval, 0.95-1.08; P<0.6688). CONCLUSIONS Controlling for covariates explains much of the adverse cardiac risk associated with antimicrobial use found in other studies. Most antimicrobials are not associated with risk of cardiac events, and others, specifically azithromycin and clarithromycin, may pose a small risk of certain cardiac events. However, the modest potential risks attributable to these antimicrobials must be weighed against the drugs' considerable and immediate benefits.
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Affiliation(s)
- Linnea A Polgreen
- Department of Pharmacy Practice and Science, University of Iowa, Iowa City, IA
| | | | | | - Saket Girotra
- Department of Internal Medicine, University of Iowa, Iowa City, IA
| | - Barry London
- Department of Internal Medicine, University of Iowa, Iowa City, IA
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA
| | - Mary C Schroeder
- Department of Pharmacy Practice and Science, University of Iowa, Iowa City, IA
| | - Philip M Polgreen
- Department of Internal Medicine, University of Iowa, Iowa City, IA
- Department of Epidemiology, University of Iowa, Iowa City, IA
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Rijkers GT, Yousif LI, Spoorenberg SM, van Overveld FJ. Triptych of the Hermit Saints: pneumococcal polysaccharide vaccines for the elderly. Risk Manag Healthc Policy 2018; 11:55-65. [PMID: 29636634 PMCID: PMC5881283 DOI: 10.2147/rmhp.s130405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Pneumococcal pneumonia is a serious disease with considerable morbidity and mortality in the elderly. Despite adequate antibiotic treatment, the long-term mortality of pneumococcal pneumonia remains high. Preventive measures in the form of vaccination, therefore, are warranted. Twenty-three-valent polysaccharide vaccines have a broad coverage but limited efficacy. Pneumococcal conjugate vaccines have been shown in children to be able to prevent invasive and mucosal pneumococcal diseases. It should be realized that the serotype composition of current pneumococcal conjugate vaccines is not tailored for the elderly, and that replacement disease can occur. Yet, the current 13-valent conjugate vaccine has been shown to protect against infections with vaccine serotypes. Long-term mortality of pneumococcal pneumonia should be included in policy making about the introduction of these vaccines for the elderly.
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Affiliation(s)
- Ger T Rijkers
- Department of Science, University College Roosevelt, Middelburg, the Netherlands.,Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Laura Ie Yousif
- Department of Science, University College Roosevelt, Middelburg, the Netherlands
| | | | - Frans J van Overveld
- Department of Science, University College Roosevelt, Middelburg, the Netherlands
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INFLUENCE OF CONCOMITANT ARTERIAL HYPERTENSION ON ACTIVITY OF INFLAMMATORY PROCESS IN PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA. EUREKA: HEALTH SCIENCES 2018. [DOI: 10.21303/2504-5679.2018.00614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of the work was to determine the diagnostic value of the markers of surfactant protein D (SP-D) and C-reactive protein (C-RP) in patients with community-acquired pneumonia (CAP) with concomitant arterial hypertension (AH) and its effects on the activity of the inflammatory process.
The study included 79 people. Among them, 63 patients with CAP and 16 healthy individuals who were a control group. Depending on the presence of hypertension, the patients were divided into two groups. The first group included 26 patients with CAP with AH, the second – 37 patients with CAP without AH. All patients were given general-clinical methods of examination, radiography of the chest organs in two projections. Plasma levels of SP-D and C-RP were determined.
Reliable connection (p<0.05) was determined between the presence of AH and the probability of occurrence of CAP (OR - odds ratio 2.27 [95 % CI 1.05–4.94]). The level of SP-D and C-RP in patients with AH on the first day was significantly higher than in healthy subjects (p<0.05). In patients in the first group, SP-D levels were significantly higher (p<0.05) for the first, third and ninth day relative to the second group. The existence of a direct tie of average strength between the presence of AH and SP-D (R=0.41, p<0.05) has been determined. The presence of a direct correlation link of mean strength (R=0.38; p<0.05) between the AH and the level of C-RP indicates that arterial hypertension in patients with CAP increases the activity of the systemic inflammatory response.
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Sandau KE, Funk M, Auerbach A, Barsness GW, Blum K, Cvach M, Lampert R, May JL, McDaniel GM, Perez MV, Sendelbach S, Sommargren CE, Wang PJ. Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e273-e344. [DOI: 10.1161/cir.0000000000000527] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Leoni D, Rello J. Cardiac arrest among patients with infections: causes, clinical practice and research implications. Clin Microbiol Infect 2017; 23:730-735. [DOI: 10.1016/j.cmi.2016.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/17/2016] [Accepted: 11/22/2016] [Indexed: 12/17/2022]
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Arnold FW. How Antibiotics Should be Prescribed to Hospitalized Elderly Patients with Community-Acquired Pneumonia. Drugs Aging 2017; 34:13-20. [PMID: 27928779 DOI: 10.1007/s40266-016-0423-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Elderly patients hospitalized with community-acquired pneumonia (CAP) should be administered antimicrobials in the emergency department prior to transfer to the ward or intensive care unit (ICU). For ward patients, a β-lactam with a macrolide or a respiratory fluoroquinolone alone should be given to cover typical and atypical pathogens. For ICU patients, a β-lactam with either a macrolide or a fluoroquinolone should be given. Other regimens are indicated if methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa is a concern. Patients who are hemodynamically stable and can tolerate oral intake can be considered for switch therapy as well as discharge if other co-morbidities are stable and a safe disposition plan exists. A number of special concerns for the elderly include noting adverse effects from antimicrobials, being watchful of comorbidity exacerbations, and vaccinating for pneumococcus and influenza.
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Affiliation(s)
- Forest W Arnold
- Division of Infectious Diseases, School of Medicine, University of Louisville, 501 E. Broadway, Suite 140 B, Louisville, KY, 40202, USA.
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Miller EJ, Linge HM. Age-Related Changes in Immunological and Physiological Responses Following Pulmonary Challenge. Int J Mol Sci 2017; 18:E1294. [PMID: 28629122 PMCID: PMC5486115 DOI: 10.3390/ijms18061294] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/08/2017] [Accepted: 06/14/2017] [Indexed: 01/07/2023] Open
Abstract
This review examines the current status of knowledge of sepsis and pneumonia in the elderly population and how the dynamics of the pulmonary challenge affects outcome and consequences. Led by an unprecedented shift in demographics, where a larger proportion of the population will reach an older age, clinical and experimental research shows that aging is associated with certain pulmonary changes, but it is during infectious insult of the lungs, as in the case of pneumonia, that the age-related differences in responsiveness and endurance become obvious and lead to a worse outcome than in the younger population. This review points to the neutrophil, and the endothelium as important players in understanding age-associated changes in responsiveness to infectious challenge of the lung. It also addresses how the immunological set-point influences injury-repair phases, remote organ damage and how intake of drugs may alter the state of responsiveness in the users. Further, it points out the importance of considering age as a factor in inclusion criteria in clinical trials, in vitro/ex vivo experimental designs and overall interpretation of results.
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Affiliation(s)
- Edmund J Miller
- The Center for Heart and Lung Research, The Feinstein Institute for Medical Research Manhasset, New York, NY 11030, USA.
- The Elmezzi Graduate School of Molecular Medicine, Manhasset, New York, NY 11030, USA.
- Hofstra Northwell School of Medicine, Hempstead, New York, NY 11549, USA.
| | - Helena M Linge
- The Center for Heart and Lung Research, The Feinstein Institute for Medical Research Manhasset, New York, NY 11030, USA.
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, 221 00 Lund, Sweden.
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Marrie TJ, Tyrrell GJ, Majumdar SR, Eurich DT. Invasive Pneumococcal Disease: Still Lots to Learn and a Need for Standardized Data Collection Instruments. Can Respir J 2017; 2017:2397429. [PMID: 28424565 PMCID: PMC5382326 DOI: 10.1155/2017/2397429] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/23/2017] [Accepted: 03/05/2017] [Indexed: 01/25/2023] Open
Abstract
Background. Large studies of invasive pneumococcal disease (IPD) are frequently lacking detailed clinical information. Methods. A population-based 15-year study of IPD in Northern Alberta. Results. 2435 patients with a mean age of 54.2 years formed the study group. Males outnumbered females and Aboriginal and homeless persons were overrepresented. High rates of smoking, excessive alcohol use, and illicit drug use were seen. Almost all (87%) had a major comorbidity and 15% had functional limitations prior to admission. Bacteremia, pneumonia, and meningitis were the most common major manifestations of IPD. Almost half of the patients had alteration of mental status at the time of admission and 22% required mechanical ventilation. Myocardial infarction, pulmonary embolism, and new onset stroke occurred in 1.7, 1.3, and 1.1% of the patients, respectively; of those who had echocardiograms, 35% had impaired ventricular function. The overall in-hospital mortality was 15.6%. Conclusions. IPD remains a serious infection in adults. In addition to immunization, preventative measures need to consider the sociodemographic features more carefully. A standard set of data need to be collected so that comparisons can be made from study to study. Future investigations should target cardiac function and pulmonary embolism prevention in this population.
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Affiliation(s)
- T. J. Marrie
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - G. J. Tyrrell
- The Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, University of Alberta and The Provincial Laboratory for Public Health, Edmonton, AB, Canada
| | - Sumit R. Majumdar
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Dean T. Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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Eurich DT, Marrie TJ, Minhas-Sandhu JK, Majumdar SR. Risk of heart failure after community acquired pneumonia: prospective controlled study with 10 years of follow-up. BMJ 2017; 356:j413. [PMID: 28193610 PMCID: PMC5421448 DOI: 10.1136/bmj.j413] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective To determine the attributable risk of community acquired pneumonia on incidence of heart failure throughout the age range of affected patients and severity of the infection.Design Cohort study.Setting Six hospitals and seven emergency departments in Edmonton, Alberta, Canada, 2000-02.Participants 4988 adults with community acquired pneumonia and no history of heart failure were prospectively recruited and matched on age, sex, and setting of treatment (inpatient or outpatient) with up to five adults without pneumonia (controls) or prevalent heart failure (n=23 060).Main outcome measures Risk of hospital admission for incident heart failure or a combined endpoint of heart failure or death up to 2012, evaluated using multivariable Cox proportional hazards analyses.Results The average age of participants was 55 years, 2649 (53.1%) were men, and 63.4% were managed as outpatients. Over a median of 9.9 years (interquartile range 5.9-10.6), 11.9% (n=592) of patients with pneumonia had incident heart failure compared with 7.4% (n=1712) of controls (adjusted hazard ratio 1.61, 95% confidence interval 1.44 to 1.81). Patients with pneumonia aged 65 or less had the lowest absolute increase (but greatest relative risk) of heart failure compared with controls (4.8% v 2.2%; adjusted hazard ratio 1.98, 95% confidence interval 1.5 to 2.53), whereas patients with pneumonia aged more than 65 years had the highest absolute increase (but lowest relative risk) of heart failure (24.8% v 18.9%; adjusted hazard ratio 1.55, 1.36 to 1.77). Results were consistent in the short term (90 days) and intermediate term (one year) and whether patients were treated in hospital or as outpatients.Conclusion Our results show that community acquired pneumonia substantially increases the risk of heart failure across the age and severity range of cases. This should be considered when formulating post-discharge care plans and preventive strategies, and assessing downstream episodes of dyspnoea.
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Affiliation(s)
- Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- ACHORD, 2-040 Li Ka Shing Center, University of Alberta, Edmonton, Alberta, Canada, T6G 2E1
| | - Thomas J Marrie
- Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Sumit R Majumdar
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- ACHORD, 2-040 Li Ka Shing Center, University of Alberta, Edmonton, Alberta, Canada, T6G 2E1
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Feldman C, Anderson R. Prevalence, pathogenesis, therapy, and prevention of cardiovascular events in patients with community-acquired pneumonia. Pneumonia (Nathan) 2016; 8:11. [PMID: 28702290 PMCID: PMC5471702 DOI: 10.1186/s41479-016-0011-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 07/04/2016] [Indexed: 12/11/2022] Open
Abstract
It is now well recognised that cardiac events occur relatively commonly in patients with acute community-acquired pneumonia. While these events are more frequent in patients with underlying risk factors—such as those with underlying chronic cardiovascular and respiratory comorbidities, the elderly, and in nursing home residents—they also occur in patients with no underlying risks other than severe pneumonia. Recent research elucidating the underlying pathogenic mechanisms related to these cardiac events has indicated a probable role for platelet activation, which is possibly exacerbated by pneumolysin in the case of pneumococcal infections. This, in turn, has resulted in the identification of possible therapeutic strategies targeting platelet activation, as well as the cardio-toxic activity of pneumolysin. These issues represent the primary focus of the current review.
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Affiliation(s)
- Charles Feldman
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Internal Medicine, University of the Witwatersrand Medical School, 7 York Road, Parktown, 2193 Johannesburg, South Africa
| | - Ronald Anderson
- Institute for Cellular and Molecular Medicine, Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Infiltrated Macrophages Die of Pneumolysin-Mediated Necroptosis following Pneumococcal Myocardial Invasion. Infect Immun 2016; 84:1457-69. [PMID: 26930705 DOI: 10.1128/iai.00007-16] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/20/2016] [Indexed: 11/20/2022] Open
Abstract
Streptococcus pneumoniae (the pneumococcus) is capable of invading the heart. Herein we observed that pneumococcal invasion of the myocardium occurred soon after development of bacteremia and was continuous thereafter. Using immunofluorescence microscopy (IFM), we observed that S. pneumoniae replication within the heart preceded visual signs of tissue damage in cardiac tissue sections stained with hematoxylin and eosin. Different S. pneumoniae strains caused distinct cardiac pathologies: strain TIGR4, a serotype 4 isolate, caused discrete pneumococcus-filled microscopic lesions (microlesions), whereas strain D39, a serotype 2 isolate, was, in most instances, detectable only using IFM and was associated with foci of cardiomyocyte hydropic degeneration and immune cell infiltration. Both strains efficiently invaded the myocardium, but cardiac damage was entirely dependent on the pore-forming toxin pneumolysin only for D39. Early microlesions caused by TIGR4 and microlesions formed by a TIGR4 pneumolysin-deficient mutant were infiltrated with CD11b(+) and Ly6G-positive neutrophils and CD11b(+) and F4/80-positive (F4/80(+)) macrophages. We subsequently demonstrated that macrophages in TIGR4-infected hearts died as a result of pneumolysin-induced necroptosis. The effector of necroptosis, phosphorylated mixed-lineage kinase domain-like protein (MLKL), was detected in CD11b(+) and F4/80(+) cells associated with microlesions. Likewise, treatment of infected mice and THP-1 macrophages in vitro with the receptor-interacting protein 1 kinase (RIP1) inhibitor necrostatin-5 promoted the formation of purulent microlesions and blocked cell death, respectively. We conclude that pneumococci that have invaded the myocardium are an important cause of cardiac damage, pneumolysin contributes to cardiac damage in a bacterial strain-specific manner, and pneumolysin kills infiltrated macrophages via necroptosis, which alters the immune response.
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Bader MS, Yi Y, Abouchehade K, Haroon B, Bishop LD, Hawboldt J. Community-Acquired Pneumonia in Patients With Diabetes Mellitus: Predictors of Complications and Length of Hospital Stay. Am J Med Sci 2016; 352:30-5. [PMID: 27432032 DOI: 10.1016/j.amjms.2016.02.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/19/2016] [Accepted: 02/23/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The primary objective of the study was to determine factors associated with complications and length of hospital stay (LOS) in hospitalized adult patients with diabetes along with community-acquired pneumonia (CAP). CAP is a common infection in patients with diabetes mellitus and is associated with a significant mortality and morbidity. MATERIALS AND METHODS This is a retrospective cohort study of 215 adult patients with diabetes who were admitted with CAP. A multivariate logistic and Cox regression analysis were used to assess factors associated with complications and LOS of CAP, respectively. RESULTS During the follow-up period from admission until discharge, 94 patients (43.7%) developed complications. Respiratory failure was the most common complication (43.6%). The average LOS of study cohort was 9.47 days. In the multivariate analysis, complications of CAP were associated with time to first dose of appropriate antibiotic therapy >8 hours since triage at emergency department (ED) (odds ratio = 3.16; 95% CI: 1.58-6.32; P = 0.001) and pneumonia severity index score >90 (odds ratio = 3.52; 95% CI: 1.45-8.53; P = 0.005). In the multivariate Cox regression analysis, time to first dose of appropriate antibiotic therapy >8 hours since triage at ED (hazard ratio [HR] = 0.56, P = 0.01), pneumonia severity index score >90 (HR = 0.62, P = 0.01), presence of complications (HR = 0.53, P = 0.002), duration of antibiotics (HR = 0.90, P ≤ 0.0001) and duration of symptoms prior presentation to ED (HR = 0.96, P = 0.04) were independently determinants of LOS. CONCLUSIONS Delayed administration of appropriate antibiotic therapy at ED and moderate-to-severe pneumonia were associated with both increased risk of complications and prolonged LOS in hospitalized adult patients with diabetes along with CAP.
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Affiliation(s)
- Mazen S Bader
- Faculty of Health Sciences, Division of Infectious Diseases, Department of Medicine, Memorial University, Newfoundland and Labrador, Canada.
| | - Yanqing Yi
- Faculty of Medicine, Division of Community Health, Memorial University, Newfoundland and Labrador, Canada
| | - Kassem Abouchehade
- School of Pharmacy, Memorial University, Newfoundland and Labrador, Canada
| | - Babar Haroon
- Department of Medicine, Memorial University, Newfoundland and Labrador, Canada
| | - Lisa D Bishop
- School of Pharmacy, Memorial University, Newfoundland and Labrador, Canada
| | - John Hawboldt
- School of Pharmacy, Memorial University, Newfoundland and Labrador, Canada
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Waterer G. Systemic corticosteroids and community-acquired pneumonia-cautious optimism or wishful thinking? J Thorac Dis 2016; 7:E622-4. [PMID: 26793375 DOI: 10.3978/j.issn.2072-1439.2015.12.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Grant Waterer
- 1 University of Western Australia, Crawley WA, Australia ; 2 Northwestern University, Chicago, USA
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Outcome of community-acquired pneumonia with cardiac complications. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2015.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Diagnoses of early and late readmissions after hospitalization for pneumonia. A systematic review. Ann Am Thorac Soc 2015; 11:1091-100. [PMID: 25079245 DOI: 10.1513/annalsats.201404-142oc] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Pneumonia is a frequent cause of hospitalization, yet drivers of post-pneumonia morbidity remain poorly characterized. Causes of hospital readmissions may elucidate important sources of morbidity and are of particular interest given the U.S. Hospital Readmission Reductions Program. OBJECTIVES To review the primary diagnoses of early (≤30 d) and late (≥31 d) readmissions after pneumonia hospitalization. METHODS Systematic review of MEDLINE, Embase, and CINAHL databases. We identified original research studies of adults aged 18 years or older, hospitalized for pneumonia, and for whom cause-specific readmission rates were reported. Two authors abstracted study results and assessed study quality. MEASUREMENTS AND MAIN RESULTS Of the 1,243 citations identified, 12 met eligibility criteria. Included studies were conducted in the United States, Spain, Canada, Croatia, and Sweden. All-cause 30-day readmission rates ranged from 16.8 to 20.1% across administrative studies; the weighted average for the studies using chart review was 11.6% (15.6% in United States-based studies). Pneumonia, heart failure/cardiovascular causes, and chronic obstructive pulmonary disease/pulmonary causes are the most common reasons for early readmission after pneumonia hospitalization. Although it was the single most common cause for readmission, pneumonia accounted for only 17.9 to 29.4% of all 30-day readmissions in administrative studies and a weighted average of 23.0% in chart review studies. After accounting for study population, there was no clear difference in findings between claims-based versus chart-review studies. Few studies assessed readmissions beyond 30 days, although the limited available data suggest similar primary diagnoses for early and late readmissions. No studies assessed whether reasons for readmission were similar to patients' reasons for healthcare use before hospitalization. CONCLUSIONS Pneumonia, heart failure/cardiovascular disease, and chronic obstructive pulmonary disease/pulmonary disease are the most common readmission diagnoses after pneumonia hospitalization. Although pneumonia was the most common readmission diagnosis, it accounted for only a minority of all readmissions. Late readmission diagnoses are less thoroughly described, and further research is needed to understand how hospitalization for pneumonia fits within the broader context of patients' health trajectory.
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Abstract
PURPOSE OF REVIEW The aim is to evaluate basic mechanisms, prevalence, risk factors, outcomes, and potential treatments of cardiovascular events (CVEs) in patients with community-acquired pneumonia (CAP). RECENT FINDINGS In this review, we present a new model to evaluate the pathophysiology of cardiac disease in patients with pneumonia based on plaque-related events, such as acute myocardial infarction, versus plaque-unrelated events, such as arrhythmias and heart failure. CAP increases the risk for both plaque-related and plaque-unrelated events with an absolute rate of CVE across different cohorts that varies broadly from 10 to 30%. These complications may happen among both ambulatory patients and inpatients, either on admission or during hospitalization, and/or after discharge. CVEs represent a major cause for increased mortality in CAP patients, contributing to more than 30% of deaths at long-term follow-up. SUMMARY From a clinical perspective, especially during the first 24 h after hospitalization, CAP patients should be tested for the probability to have or develop during hospitalization a cardiac event. From a research point of view, there is an urgent need to prospectively evaluate cardioprotective interventions.
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Rajas O, Ortega-Gómez M, Galván Román JM, Curbelo J, Fernández Jiménez G, Vega Piris L, Rodríguez Salvanes F, Arnalich B, Luquero Bueno S, Díaz López A, de la Fuente H, Suárez C, Ancochea J, Aspa J. The incidence of cardiovascular events after hospitalization due to CAP and their association with different inflammatory markers. BMC Pulm Med 2014; 14:197. [PMID: 25495677 PMCID: PMC4320510 DOI: 10.1186/1471-2466-14-197] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 12/04/2014] [Indexed: 01/13/2023] Open
Abstract
Background Late prognosis of Community-Acquired Pneumonia (CAP) patients is related to cardiovascular events. Persistence of inflammation-related markers, defined by high circulatory levels of interleukin 6 and 10 (IL-6/IL-10), is associated with a higher post-event mortality rate for CAP patients. However, association between these markers and other components of the immune response, and the risk of cardiovascular events, has not been adequately explored. The main objectives of this study are: 1) to quantify the incidence of cardiovascular disease, in the year post-dating their hospital admittance due to CAP and, 2) to describe the distribution patterns of a wide spectrum of inflammatory markers upon admittance to and release from hospital, and to determine their relationship with the incidence of cardiovascular disease. Methods/design A cohort prospective study. All patients diagnosed and hospitalized with CAP will be candidates for inclusion. The study will take place in the Universitary Hospital La Princesa, Spain, during two years. Two samples of blood will be taken from each patient: the first upon admittance and the second one prior to release, in order to analyse various immune agents. The main determinants are: pro-adrenomedullin, copeptin, IL-1, IL-6, TNF-α, IL-17, IFN-γ, IL-10 and TGF-β, E-Selectin, ICAM-1, VCAM-1 and subpopulations of peripheral T lymphocytes (T regulator, Th1 and Th17), together with other clinical and analytical variables. Follow up will start at admittance and finish a year after discharge, registering incidence of death and cardiovascular events. The main objective is to establish the predictive power of different inflammatory markers in the prognosis of CAP, in the short and long term, and their relationship with cardiovascular disease. Discussion The level of some inflammatory markers (IL-6/IL-10) has been proposed as a means to differentiate the degree of severity of CAP, but their association with cardiovascular risk is not well established. In this study we aim to define new inflammatory markers associated with cardiovascular disease that could be helpful for the prognosis of CAP patients, by describing the distribution of a wide spectrum of inflammatory mediators and analyzing their association with the incidence of cardiovascular disease and mortality one year after release from hospital.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Javier Aspa
- Servicio de Neumología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Hospital Universitario de la Princesa, IP, Madrid, España.
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Colombo A, Proietti R, Culić V, Lipovetzky N, Viecca M, Danna P. Triggers of acute myocardial infarction: a neglected piece of the puzzle. J Cardiovasc Med (Hagerstown) 2014; 15:1-7. [PMID: 24500234 DOI: 10.2459/jcm.0b013e3283641351] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The existence of specific risk factors for the development of coronary heart disease, both chronic and acute, has been extensively investigated and is well understood by cardiology professionals. Diabetes, hypertension, hypercholesterolemia, psychological patterns and smoking are assumed to interact in a complex way with individual heritable predisposition, thus determining the long-term probability of coronary disease. However, the possibility that defined circumstances and activities may act as immediate triggers of acute coronary syndromes, particularly acute myocardial infarction, has not been given comparable attention in clinical research. For example, the recently issued 2012 European guidelines on cardiovascular disease prevention completely overlook the topic of triggers and their possible prevention. This review presents a picture of the most reliable evidence regarding the triggering of myocardial infarction and contributes to further investigation in the field.
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Affiliation(s)
- Alessandro Colombo
- aCardiology Department, 'Luigi Sacco' Hospital, Milano, Italy bCardiology Division, University Hospital Centre, Split, Croatia cMaccabi Healthcare Services, Tel Aviv, Israel
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50
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Violi F, Cangemi R, Calvieri C. Pneumonia, thrombosis and vascular disease. J Thromb Haemost 2014; 12:1391-400. [PMID: 24954194 DOI: 10.1111/jth.12646] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Indexed: 02/06/2023]
Abstract
SUMMARY An enhanced risk of cardiovascular mortality has been observed after pneumonia. Epidemiological studies have shown that respiratory tract infections are associated with an increased risk of thrombotic-related vascular disease such as myocardial infarction, ischemic stroke and venous thrombosis. Myocardial infarction and stroke have been detected essentially in the early phase of the disease (i.e. within 48 h from hospital admission), with an incidence ranging from as low as 1% to as high as 11%. Age, previous cardiovascular events and high pneumonia severity index were independent predictors of myocardial infarction; clinical predictors of stroke were not identified. Deep venous thrombosis and pulmonary embolism may also occur after pneumonia but incidence and clinical predictors must be defined. The biological plausibility of such an association may be deduced by experimental and clinical studies, showing that lung infection is complicated by platelet aggregation and clotting system activation, as documented by up-regulation of tissue factor and down-regulation of activated protein C. The effect of antithrombotic drugs has been examined in experimental and clinical studies but results are still inconclusive.
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Affiliation(s)
- F Violi
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
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