Prognostic Factors for Cardiovascular Events in Elderly Patients with Community Acquired Pneumonia: Results from the CAP-China Network

Abstract

Xiudi Han,1 Liang Chen,2 Hui Li,3 Fei Zhou,3 Xiqian Xing,4 Chunxiao Zhang,5 Lijun Suo,6 Jinxiang Wang,7 Xuedong Liu,1 Bin Cao3 On behalf of the CAP-China network1Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital Group, Qingdao City, Shandong Province, 266011, People’s Republic of China; 2Department of Infectious Diseases, Nanjing Lishui People’s Hospital, Nanjing City, Jiangsu Province, 211213, People’s Republic of China; 3National Clinical Research Center of Respiratory Diseases, Center for Respiratory Diseases, China-Japan Friendship Hospital; Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100020, People’s Republic of China; 4Department of Respiratory Medicine, Yan’an Hospital Affiliated to Kunming Medical University, Kunming City, Yunnan Province, 652199, People’s Republic of China; 5Department of Respiratory Medicine, Beijing Huimin Hospital, Beijing, 100054, People’s Republic of China; 6Department of Pulmonary and Critical Care Medicine, Zibo Municipal Hospital, Zibo City, Shandong Province, 255000, People’s Republic of China; 7Department of Respiratory Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of ChinaCorrespondence: Xuedong Liu, Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital Group, Jiaozhou Road, Qingdao City, Shandong Province, 266011, People’s Republic of China, Tel [phone], Fax [phone], Email [email protected] Bin Cao, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Yinghuayuan East Street, Chao-Yang District, Beijing, 100020, People’s Republic of China, Tel [phone], Fax [phone], Email [email protected]: Limited data were available about the burden of cardiovascular events (CVEs) during hospitalization in elderly patients with community-acquired pneumonia (CAP). The aim was to assess the incidence, characteristics, predictive factors and outcomes of CVEs in elderly patients with CAP during hospitalization.Methods: This study was a multicenter, retrospective research on hospitalized elderly patients with CAP from the CAP-China network. Predictive factors for the occurrence of CVEs and 30-day mortality were identified by multivariable logistic regression analysis.Results: Of 2941 hospitalized elderly patients, 402 (13.7%) developed CVEs during hospitalization with the median age of 81 years old. Compared with non-CVEs patients, patients with CVEs were older, more comorbidities, and higher disease severity; use of glucocorticoids, leukocytosis, azotemia, hyponatremia, multilobe infiltration and pleural effusion were more common; the rate of clinical failure (CF), in-hospital mortality and 30-day mortality were higher, which significantly increased with age and the number of CVEs (p < 0.001). Multivariable logistic regression showed previous history of congestive heart failure (odds ratio [OR], 6.16; 95% CI, 4.14– 9.18), CF (OR, 4.69; 95% CI, 3.392– 6.48), previous history of ischemic heart disease (OR, 2.22; 95% CI, 1.61– 3.07), use of glucocorticoids (OR, 2.0; 95% CI, 1.39– 2.89), aspiration (OR, 1.88; 95% CI, 1.26– 2.81), pleural effusion (OR, 1.66; 95% CI, 1.25– 2.20), multilobe infiltration (OR, 1.50; 95% CI, 1.15– 1.96), age (OR, 1.05; 95% CI, 1.04– 1.07), and blood urea nitrogen (OR, 1.03; 95% CI, 1.01– 1.06) were independent predictors for the occurrence of CVEs, while level of blood sodium (OR, 0.98; 95% CI, 0.97– 0.99) was protective factor. Renal failure (OR, 9.46; 95% CI, 4.17– 21.48), respiratory failure (OR, 9.32; 95% CI, 5.91– 14.71), sepsis/septic shock (OR, 7.87; 95% CI, 3.58– 17.31), new cerebrovascular diseases (OR, 5.94; 95% CI, 1.78– 19.87), new heart failure (OR, 4.04; 95% CI, 1.15– 14.14), new arrhythmia (OR, 2.38; 95% CI, 1.11– 5.14), aspiration (OR, 1.95; 95% CI, 1.09– 3.50), CURB-65 (OR, 1.57; 95% CI, 1.21– 2.02), and white blood cell count (OR, 1.05; 95% CI, 1.02– 1.09) were independent predictors for 30-day mortality in elderly patients with CAP, while lymphocyte count (OR, 0.63; 95% CI, 0.46– 0.87) was protective factor.Conclusion: Patients with CVEs had heavier disease burden and worse prognosis. Early recognition of risk factors is meaningful to strengthen the management in elderly patients with CAP.Keywords: community-acquired pneumonia, cardiovascular events, prognostic factors, elderly

Keywords

• community-acquired pneumonia
• cardiovascular events
• prognostic factors
• elderly