121. Risk Factors for Cardiovascular Events in Hospitalized Patients with Community-Acquired Pneumonia
Session: Oral Abstract Session: Epidemiology of Respiratory Infections
Thursday, October 3, 2013: 10:45 AM
Room: The Moscone Center: 300

Background:   An increased risk of cardiovascular complications has been found in those with community-acquired pneumonia (CAP).  Preliminary data have suggested pneumococcal pneumonia, more severe pneumonia, older age, chronic renal disease, hypoalbuminemia, and inpatient sliding scale insulin administration contribute to risk.  The objective of this study was to ascertain additional factors influencing cardiovascular events in CAP and to clarify previously elucidated risk factors.

Methods: This investigation was a multicenter, retrospective cohort study of inpatients ≥ 16 years of age with CAP.  The primary outcome was development of a cardiovascular event during hospitalization defined as acute pulmonary edema, new onset of a cardiac arrhythmia, exacerbation of a previously diagnosed arrhythmia, or myocardial infarction.  Those with and without events were compared across cardiovascular and pneumonia specific variables by multivariate logistic regression to discern factors that independently influence risk for a cardiac event. 

Results: Of 3068 inpatients with CAP, 376 (12%) developed a cardiovascular incident during hospitalization, the most common event of which was exacerbation of a previously diagnosed arrhythmia.  Hyperlipidemia (odds ratio 1.90; 95 % confidence interval 1.27-2.83); Staphylococcus aureus (OR 1.76; 95 % CI 1.02-3.05) or Klebsiella pneumoniae (OR 2.81; 95 % CI 1.05-7.50) as etiologies; use of a macrolide as part of CAP therapy (OR 1.49; 95 % CI 1.12 to 1.98); and more severe pneumonia (OR 1.02; 95 % CI 1.01-1.02) were associated with increased cardiac risk while statin use was associated with decreased risk (OR 0.54; 95% CI 0.35-0.84). 

Conclusion: This study highlights variables in CAP patients that should make clinicians vigilant for the development of cardiac complications.  Furthermore, these results suggest avoiding macrolides in those with cardiovascular comorbidities and pneumonia.  However, additional research is needed to determine if statins truly attenuate cardiac risk in those with CAP and cardiovascular comorbidities and to discern if this class of medicines would be beneficial to administer prophylactically in addition to standard CAP therapy for those at elevated risk for coronary events.

 

Allen Griffin II, MD, Timothy L. Wiemken, PhD, MPH, CIC and Forest Arnold, DO, Division of Infectious Diseases, University of Louisville, Louisville, KY

Disclosures:

A. Griffin II, None

T. L. Wiemken, None

F. Arnold, None

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