Putot Alain, Bouhey Emmanuel, Tetu Jennifer, Barben Jérémy, Timsit Eléonore, Putot Sophie, Ray Patrick, Manckoundia Patrick
Geriatrics Internal Medicine Department, Centre Hospitalier Universitaire Dijon Bourgogne, 21000 Dijon, France.
Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, Université Bourgogne Franche Comté, 21000 Dijon, France.
J Clin Med. 2020 Nov 10;9(11):3623. doi: 10.3390/jcm9113623.
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), = 0.003). Myocardial injury was strongly associated with in-hospital myocardial infarction (25% vs. 0%, < 0.001), CV mortality (11 vs. 1%, = 0.003) and all-cause mortality (34 vs. 13%, = 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), = 0.005) but not one-year mortality (1.61 (0.77-3.35), = 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.
心血管（CV）事件在老年人急性肺炎（AP）后尤为常见。我们旨在评估心肌损伤的特异性生物标志物心肌肌钙蛋白I是否能独立预测老年住院患者AP后的CV事件和死亡。在一所大学医院收治的214例年龄≥75岁的连续AP患者中，纳入了171例在AP诊断后72小时内采集心肌肌钙蛋白I样本的患者，其中71例（42%）被发现有心肌损伤（肌钙蛋白>100 ng/L）。有和没有心肌损伤的患者在年龄、性别和合并症方面相似，但有心肌损伤的患者临床表现更严重（中位数（四分位间距）肺炎严重程度指数：60（40 - 95）对45（30 - 70），P = 0.003）。心肌损伤与院内心肌梗死密切相关（25%对0%，P < 0.001）、CV死亡率（11%对1%，P = 0.003）和全因死亡率（34%对13%，P = 0.002）。在对混杂因素进行调整后，心肌损伤仍然是院内死亡率的强预测因素（比值比（95%置信区间）：3.32（1.42 - 7.73），P = 0.005），但不是一年死亡率的预测因素（1.61（0.77 - 3.35），P = 0.2）。在一组未经选择的老年AP住院患者中，近一半发现了心肌损伤的特异性生物标志物心肌肌钙蛋白I升高，且其与院内死亡风险增加三倍相关。
