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

Abstract

Background

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

Abbreviations

CVEs, cardiovascular events; CAP, community-acquired pneumonia; CHF, congestive heart failure; CVDs, cerebrovascular diseases; CF, clinical failure; OR, odds ratio; ICU, intensive care unit; WHO, World Health Organization; LOS, length of stay; BNP, brain natriuretic peptide; NT-proBNP, N-terminal pro-B-type natriuretic peptide; AMI, acute myocardial infarction; PE, pulmonary embolism; DVT, deep venous thrombosis; IQR, interquartile range; CIs, confidence intervals; DIC, diffuse intravascular coagulation; BUN, blood urea nitrogen; WBC, white blood cell; PSI, pneumonia severity index; T2MI, type 2 myocardial infarction; CAPO, Community-Acquired Pneumonia Organization; ICECAP, Implications of acute Cardiovascular Events in patients hospitalized for Community-Acquired Pneumonia; DIC, disseminated intravascular coagulation; COPD, chronic obstructive pulmonary disease; HCAP, healthcare-associated pneumonia; RR, respiratory rate; HR, heart rate; HCT, hematocrit; Cr, creatinine; Na, sodium; PaO₂/FiO_2, partial arterial oxygen pressure/fraction of inspired oxygen; PaO_2, partial arterial oxygen pressure; SaO₂, arterial oxygen saturation; CT, computed tomography.

Data Sharing Statement

All data generated or analyzed during this study are included in this published article and its supplementary information files.

Ethics Approval and Informed Consent

This study was approved by the China-Japan Friendship Hospital Ethics Committee (No. 2015–85) on October 12, 2015. We also confirmed that all patient data was treated with confidentiality, in accordance with the Declaration of Helsinki.

Consent for Publication

All authors have confirmed that the details of the paper.

Acknowledgments

The authors are grateful for the contributions of all the staff of the CAP-China network for their help with data collection and input. Thanks to Yimin Wang, Guangqiang Wang, Xuexin Yao, Hongxia Yu, Guohua Yu, Meng Liu, Chunxue Xue, Bo Liu, Xiaoli Zhu, Yanli Li, Ying Xiao, Xiaojing Cui, Lijuan Li, and Lei Wang for collecting the information. Thanks to Yi Wang for revising the figures.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.

Additional information

Funding

This work was supported by the National Science Grant for Distinguished Young Scholars (grant number 81425001/H0104), the National Key Technology Support Program from Ministry of Science and Technology (grant number 2015BAI12B11) and the Beijing Science and Technology Project (grant number D151100002115004).