老年人复发性心包炎：临床和实验室特征及预后。

Recurrent pericarditis in older adults: Clinical and laboratory features and outcome.

机构信息

Internal Medicine Department, Fatebenefratelli and Sacco Hospitals, Milan, Italy.

Clinical Cardiology and Cardiovascular Imaging Unit, Galeazzi-Sant'Ambrogio Hospital IRCCS, Milan, Italy.

出版信息

J Am Geriatr Soc. 2024 Nov;72(11):3467-3475. doi: 10.1111/jgs.19150. Epub 2024 Sep 9.

DOI:10.1111/jgs.19150

PMID:39247990

Abstract

BACKGROUND

Current guidelines for the diagnosis and treatment of pericarditis refer to the general adult population. Few and fragmentary data regarding recurrent pericarditis in older adults exist.

OBJECTIVE OF THE STUDY

Given the absence of specific data in scientific literature, we hypothesized that there might be clinical, laboratory and outcome differences between young adults and older adults affected by idiopathic recurrent pericarditis.

MATERIALS AND METHODS

We performed an international multicentric retrospective cohort study analyzing data from patients affected by recurrent pericarditis (idiopathic or post-cardiac injury) and referring to tertiary referral centers. Clinical, laboratory, and outcome data were compared between patients younger than 65 years (controls) and patients aged 65 or older.

RESULTS

One hundred and thirty-three older adults and 142 young adult controls were enrolled. Comorbidities, including chronic kidney diseases, atrial fibrillation, and diabetes, were more present in older adults. The presenting symptom was dyspnea in 54.1% of the older adults versus 10.6% in controls (p < 0.001); pain in 32.3% of the older adults versus 80.3% of the controls (p < 0.001). Fever higher than 38°C was present in 33.8% versus 53.5% (p = 0.001). Pleural effusion was more prevalent in the older adults (55.6% vs 34.5%, p < 0.001), as well as severe pericardial effusion (>20 mm) (24.1% vs 12.7%, p = 0.016) and pericardiocentesis (16.5% vs 8.5%, p = 0.042). Blood leukocyte counts were significantly lower in the older adults (mean + SE: 10,227 + 289/mm vs 11,208 + 285/mm, p = 0.016). Concerning therapies, NSAIDS were used in 63.9% of the older adults versus 80.3% in the younger (p = 0.003), colchicine in 76.7% versus 87.3% (p = 0.023), corticosteroids in 49.6% versus 26.8% (p < 0.001), and anakinra in 14.3% versus 23.9% (p = 0.044).

CONCLUSIONS

Older adults affected by recurrent pericarditis show a different clinical pattern, with more frequent dyspnea, pleural effusion, severe pericardial effusion, and lower fever and lower leukocyte count, making the diagnosis sometimes challenging. They received significantly less NSAIDs and colchicine, likely due to comorbidities; they were also treated less commonly with anti-IL1 agents, and more frequently with corticosteroids.

摘要

背景

目前关于心包炎的诊断和治疗指南适用于一般成年人群。关于老年人复发性心包炎的数据很少且零散。

目的

鉴于科学文献中缺乏具体数据，我们假设年轻人和老年人之间可能存在特发性复发性心包炎的临床、实验室和结局差异。

材料和方法

我们进行了一项国际多中心回顾性队列研究，分析了来自患有复发性心包炎（特发性或心脏损伤后）并就诊于三级转诊中心的患者的数据。将 65 岁以下的患者（对照组）与 65 岁或以上的患者进行临床、实验室和结局数据比较。

结果

共纳入 133 名老年患者和 142 名年轻成年对照组。老年患者更易合并慢性肾脏病、心房颤动和糖尿病等合并症。54.1%的老年患者首发症状为呼吸困难，而对照组为 10.6%（p<0.001）；32.3%的老年患者首发症状为疼痛，而对照组为 80.3%（p<0.001）。33.8%的老年患者发热高于 38°C，而对照组为 53.5%（p=0.001）。老年患者胸腔积液更常见（55.6% vs 34.5%，p<0.001），重度心包积液（>20mm）（24.1% vs 12.7%，p=0.016）和心包穿刺术（16.5% vs 8.5%，p=0.042）也更常见。老年患者白细胞计数显著降低（均值+SE：10227+289/mm vs 11208+285/mm，p=0.016）。在治疗方面，老年患者中 63.9%使用非甾体抗炎药，而年轻患者中为 80.3%（p=0.003），76.7%使用秋水仙碱，而年轻患者中为 87.3%（p=0.023），49.6%使用皮质类固醇，而年轻患者中为 26.8%（p<0.001），14.3%使用阿那白滞素，而年轻患者中为 23.9%（p=0.044）。