1 Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
2 Department of Cardiology, School of Medical Sciences, Örebro University, Örebro, Sweden.
Eur J Prev Cardiol. 2017 Dec;24(18):1958-1966. doi: 10.1177/2047487317724009. Epub 2017 Aug 1.
Background Severe infections in adulthood are associated with subsequent short-term cardiovascular disease. Whether hospital admission for sepsis or pneumonia is associated with persistent increased risk (over a year after infection) is less well established. Design The design of this study was as a register-based cohort study. Methods Some 236,739 men born between 1952-1956 were followed from conscription assessments in adolescence to 2010. All-cause cardiovascular disease ( n = 46,754), including coronary heart disease ( n = 10,279) and stroke ( n = 3438), was identified through national registers 1970-2010 (at ages 18-58 years). Results Sepsis or pneumonia in adulthood (resulting in hospital admission) are associated with increased risk of cardiovascular disease in the years following infection. The risk is highest during the first year after the infection, with an adjusted hazard ratio (and 95% confidence intervals) of 6.33 (5.65-7.09) and a notably increased risk persisted with hazard ratios of 2.47 (2.04-3.00) for the second and 2.12 (1.71-2.62) for the third year after infection. The risk attenuated with time, but remained raised for at least five years after infection; 1.87 (1.47-2.38). The results are adjusted for characteristics in childhood, cardiovascular risk factors and medical history in adolescence. Similar statistically significant associations were found for coronary heart disease and stroke. Conclusions Raised risks of cardiovascular disease following hospital admission for sepsis or pneumonia were increased for more than five years after the infection, but with the highest magnitude during the first three years following infection, suggesting a period of vulnerability when health professionals and patients should be aware of the heightened risk for cardiovascular disease.
背景:成年人严重感染与随后的短期心血管疾病有关。因败血症或肺炎住院是否与持续增加的风险(感染后一年以上)相关,目前尚不清楚。
设计:本研究设计为基于登记的队列研究。
方法:1952-1956 年间出生的 236739 名男性,从青春期入伍评估开始,随访至 2010 年。1970-2010 年期间通过国家登记系统(18-58 岁)确定全因心血管疾病(n=46754),包括冠心病(n=10279)和中风(n=3438)。
结果:成年人(导致住院)败血症或肺炎与感染后数年心血管疾病风险增加有关。感染后第一年风险最高,调整后的危险比(95%置信区间)为 6.33(5.65-7.09),第二年和第三年风险持续增加,危险比分别为 2.47(2.04-3.00)和 2.12(1.71-2.62)。风险随时间减弱,但感染后至少五年仍处于升高状态;1.87(1.47-2.38)。结果根据儿童期特征、心血管危险因素和青春期病史进行了调整。对于冠心病和中风,也发现了类似的统计学显著关联。
结论:败血症或肺炎住院后心血管疾病风险增加超过五年,但感染后前三年风险最高,这表明存在易受影响的时期,健康专业人员和患者应意识到心血管疾病风险增加。
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