Underwood Jonathan, Reeve Nicola, Best Victoria, Akbari Ashley, Ahmed Haroon
Infection and Immunity, Cardiff University, Cardiff, UK
Infectious Diseases, Cardiff and Vale University Health Board, Cardiff, UK.
Open Heart. 2025 Mar 25;12(1):e003241. doi: 10.1136/openhrt-2025-003241.
Cardiovascular disease (CVD) events triggered by inflammation are an underappreciated and poorly quantified cause of morbidity and mortality in patients with bloodstream infections (BSIs). We aimed to determine the risk of myocardial infarction (MI) and stroke after BSI.
This self-controlled case series study was conducted within the Secure Anonymised Information Linkage Databank, containing anonymised population-scale electronic health record data for Wales, UK. We included adults with community-acquired BSI between 2010 and 2020. MI and stroke were determined from International Classification of Disease Version 10 coded admissions. Predefined risk periods after BSI were compared with the baseline period using pseudo-Poisson regression adjusted for age. Maximum C-reactive protein (CRP), a proxy for the magnitude of the inflammatory response, was determined within the first 7 days after BSI.
We identified 50 450 individuals with MI and 56 890 with stroke, of whom 1000 and 1290, respectively, also had at least one community-associated BSI. The risk of MI was most elevated in the first 1-7 days after BSI (adjusted incidence rate ratio (IRR) (95% CI): 9.67 (6.54 to 14.3)) and returned to baseline after 28 days. The risk was similarly elevated for stroke.The largest magnitude of risk was observed for those with a maximal CRP>300 mg/L (MI IRR: 21.54 (9.57 to 48.52); stroke IRR: 6.94 (3.14 to 15.32)).
BSI is associated with an increased risk of CVD events in the first 2 weeks after infection. Greater systemic inflammation was associated with a higher risk of CVD events and suggests targeting the inflammatory response caused by BSI warrants further study.
炎症引发的心血管疾病（CVD）事件是血流感染（BSI）患者发病和死亡的一个未得到充分认识且量化不足的原因。我们旨在确定BSI后心肌梗死（MI）和中风的风险。
这项自我对照病例系列研究在安全匿名信息链接数据库中进行，该数据库包含英国威尔士的匿名人口规模电子健康记录数据。我们纳入了2010年至2020年间社区获得性BSI的成年人。MI和中风通过国际疾病分类第10版编码的入院记录确定。使用针对年龄调整的伪泊松回归，将BSI后的预定义风险期与基线期进行比较。在BSI后的前7天内测定最大C反应蛋白（CRP），作为炎症反应程度的指标。
我们确定了50450例MI患者和56890例中风患者，其中分别有1000例和1290例也至少有一次社区相关性BSI。MI风险在BSI后的前1至7天最高（调整后的发病率比（IRR）（95%CI）：9.67（6.54至14.3）），28天后恢复到基线水平。中风风险同样升高。最大CRP>300mg/L的患者风险最高（MI IRR：21.54（9.57至48.52）；中风IRR：6.94（3.14至15.32））。
BSI与感染后前2周内CVD事件风险增加相关。更强的全身炎症与更高的CVD事件风险相关，提示针对BSI引起的炎症反应进行干预值得进一步研究。
