Rombauts Alexander, Abelenda-Alonso Gabriela, Càmara Jordi, Lorenzo-Esteller Laia, González-Díaz Aida, Sastre-Escolà Enric, Gudiol Carlota, Dorca Jordi, Tebé Cristian, Pallarès Natàlia, Ardanuy Carmen, Carratalà Jordi
Department of Infectious Diseases, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain.
Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain.
Open Forum Infect Dis. 2020 Oct 26;7(12):ofaa522. doi: 10.1093/ofid/ofaa522. eCollection 2020 Dec.
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.
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.
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).
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.
急性心脏事件（ACEs）日益被认为是肺炎球菌社区获得性肺炎（CAP）的主要并发症。关于ACEs的宿主和病原体相关因素的信息，包括肺炎球菌血清型和克隆复合体，非常匮乏。
对1996年至2019年因CAP住院的前瞻性队列患者进行回顾性研究。进行逻辑回归和漏斗图分析以确定ACEs的宿主和病原体相关因素。
在1739例肺炎球菌CAP发作中，304例（17.5%）患者发生了1次或更多次ACEs，最常见的是心律失常（n = 207）、心力衰竭（n = 135）和心肌梗死（n = 23）。大多数ACEs（73.4%）发生在入院后48小时内。与ACEs独立相关的因素包括年龄较大、既往有心脏疾病、肺炎球菌菌血症、入院时感染性休克和高危肺炎。在983株肺炎球菌分离株中，872株（88.7%）进行了血清分型，742株（75.5%）进行了基因分型。漏斗图分析未发现血清型或克隆复合体与ACEs之间存在任何统计学上的显著关联。然而，CC230与这些并发症之间存在关联趋势。ACEs与30天死亡率独立相关（调整后的优势比为1.88；95%CI为1.11 - 3.13）。
ACEs在肺炎球菌肺炎中很常见，并与死亡率增加相关。本研究确定的危险因素可能有助于识别必须接受密切随访的患者，包括心律监测，以及特别护理以避免液体超负荷，尤其是在入院后的头48小时内。这些高危患者应成为预防性干预策略的目标。
