Background
Community-acquired pneumonia (CAP) increases the risk of cardiovascular complications
during and following the episode. The goal of this study was to determine the usefulness
of cardiovascular and inflammatory biomarkers for assessing the risk of early (within
30 days) or long-term (1-year follow-up) cardiovascular events.
Methods
A total of 730 hospitalized patients with CAP were prospectively followed up during
1 year. Cardiovascular (proadrenomedullin [proADM], pro-B-type natriuretic peptide
(proBNP), proendothelin-1, and troponin T) and inflammatory (interleukin 6 [IL-6],
C-reactive protein, and procalcitonin) biomarkers were measured on day 1, at day 4/5,
and at day 30.
Results
Ninety-two patients developed an early event, and 67 developed a long-term event.
Significantly higher initial levels of proADM, proendothelin-1, troponin, proBNP,
and IL-6 were recorded in patients who developed cardiovascular events. Despite a
decrease at day 4/5, levels remained steady until day 30 in those who developed late
events. Biomarkers (days 1 and 30) independently predicted cardiovascular events adjusted
for age, previous cardiac disease, Pa
o
2/F
io
2 < 250 mm Hg, and sepsis: ORs (95% CIs), proendothelin-1, 2.25 (1.34-3.79); proADM,
2.53 (1.53-4.20); proBNP, 2.67 (1.59-4.49); and troponin T, 2.70 (1.62-4.49) for early
events. For late events, the ORs (95% CIs) were: proendothelin-1, 3.13 (1.41-7.80);
proADM, 2.29 (1.01-5.19); and proBNP, 2.34 (1.01-5.56). Addition of IL-6 levels at
day 30 to proendothelin-1 or proADM increased the ORs to 3.53 and 2.80, respectively.
Conclusions
Cardiac biomarkers are useful for identifying patients with CAP at high risk for early
and long-term cardiovascular events. They may aid personalized treatment optimization
and for designing future interventional studies to reduce cardiovascular risk.
Key Words
Abbreviations:
AMI ( acute myocardial infarction), AUROC ( area under the receiver-operating curve), CAP ( community-acquired pneumonia), CRP ( C-reactive protein), PCT ( procalcitonin), proADM ( proadrenomedullin), proBNP ( pro-B-type natriuretic peptide)To read this article in full you will need to make a payment
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References
- Community-acquired pneumonia.Lancet. 2015; 386: 1097-1108
- Assessment of mortality after long-term follow-up of patients with community-acquired pneumonia.Clin Infect Dis. 2003; 37: 1617-1624
- Decrease in long-term survival for hospitalized patients with community-acquired pneumonia.Chest. 2010; 138: 279-283
- Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease.JAMA. 2015; 313: 264-274
- Acute myocardial infarction versus other cardiovascular events in community-acquired pneumonia.ERJ Open Res. 2015; 1
- Acute myocardial infarction in hospitalized patients with community-acquired pneumonia.Clin Infect Dis. 2008; 47: 182-187
- Cardiovascular complications and short-term mortality risk in community-acquired pneumonia.Clin Infect Dis. 2017; 64: 1486-1493
- Cardiac diseases complicating community-acquired pneumonia.Curr Opin Infect Dis. 2014; 27: 295-301
- Community-acquired pneumonia: pathogenesis of acute cardiac events and potential adjunctive therapies.Chest. 2015; 148: 523-532
- Intermediate and long-term risk of new-onset heart failure after hospitalization for pneumonia in elderly adults.Am Heart J. 2015; 170: 306-312
- Is community-acquired pneumonia an independent risk factor for cardiovascular disease?.Eur Respir J. 2012; 39: 187-196
- Pneumonia and the risk of cardiovascular death. Time to change our strategy.Am J Respir Crit Care Med. 2017; 196: 541-543
- Future research directions in pneumonia.Am J Respir Crit Care Med. 2018; 198: 256-263
- The relationship between lung inflammation and cardiovascular disease.Am J Respir Crit Care Med. 2012; 186: 11-16
- Coronary artery calcium before and after hospitalization with pneumonia: the MESA study.PloS One. 2018; 13e0191750
- Severe pneumococcal pneumonia causes acute cardiac toxicity and subsequent cardiac remodeling.Am J Respir Crit Care Med. 2017; 196: 609-620
- Cardiotoxicity during invasive pneumococcal disease.Am J Respir Crit Care Med. 2015; 191: 739-745
- Cardiovascular and inflammatory biomarkers to predict short- and long-term survival in community-acquired pneumonia: results from the German Competence Network, CAPNETZ.Am J Respir Crit Care Med. 2010; 182: 1426-1434
- Inflammatory markers at hospital discharge predict subsequent mortality after pneumonia and sepsis.Am J Respir Crit Care Med. 2008; 177: 1242-1247
- Endothelin-1 and its role in the pathogenesis of infectious diseases.Life Sci. 2014; 118: 110-119
- Antimicrobial treatment failures in patients with community-acquired pneumonia: causes and prognostic implications.Am J Respir Crit Care Med. 2000; 162: 154-160
- A prediction rule to identify low-risk patients with community-acquired pneumonia.N Engl J Med. 1997; 336: 243-250
- Cardiac complications in patients with community-acquired pneumonia: a systematic review and meta-analysis of observational studies.PLoS Med. 2011; 8e1001048
- Cardiac complications in patients with community-acquired pneumonia incidence, timing, risk factors, and association with short-term mortality.Circulation. 2012; 125: 773-781
- Cardiac troponin I as a prognostic factor in critically ill pneumonia patients in the absence of acute coronary syndrome.J Crit Care. 2015; 30: 390-394
- Pneumonia presenting with organ dysfunctions: causative microorganisms, host factors and outcome.J Infect. 2016; 73: 419-426
- Elevated hemostasis markers after pneumonia increases one-year risk of all-cause and cardiovascular deaths.PloS One. 2011; 6e22847
- Clinical risk scores and blood biomarkers as predictors of long-term outcome in patients with community-acquired pneumonia: a 6-year prospective follow-up study.J Intern Med. 2015; 278: 174-184
- Prognostic value of mid-regional pro-adrenomedullin (MR-proADM) in patients with community-acquired pneumonia: a systematic review and meta-analysis.BMC Infect Dis. 2016; 16: 232
- Direct comparison of three natriuretic peptides for prediction of short- and long-term mortality in patients with community-acquired pneumonia.Chest. 2012; 141: 974-982
- Prognostic value of brain natriuretic peptide in heart transplant patients.J Heart Lung Transplant. 2007; 26: 986-991
- Interleukin-6 and the risk of adverse outcomes in patients after an acute coronary syndrome: observations from the SOLID-TIMI 52 (Stabilization of Plaque Using Darapladib-Thrombolysis in Myocardial Infarction 52) Trial.J Am Heart Assoc. 2017; 6
- Cardiac troponin elevation in patients without a specific diagnosis.J Am Coll Cardiol. 2019; 73: 1-9
- Circulating interleukin-6 levels and cardiovascular and all-cause mortality in the elderly population: a meta-analysis.Arch Gerontol Geriatr. 2017; 73: 257-262
- 2016 European guidelines on cardiovascular disease prevention in clinical practice.Eur Heart J. 2016; 37: 2315-2381
- Reaching cardiovascular prevention guideline targets with a polypill-based approach: a meta-analysis of randomised clinical trials.Heart. 2019; 105: 42-48
- Dabigatran in Patients with Myocardial Injury After Non-Cardiac Surgery (MANAGE): an international, randomised, placebo-controlled trial.Lancet. 2018; 391: 2325-2334
- Ticagrelor reduces thromboinflammatory markers in patients with pneumonia.JACC Basic Transl Sci. 2018; 3: 435-449
Article Info
Publication History
Published online: August 02, 2019
Footnotes
FUNDING/SUPPORT: This work was supported by the following: Instituto de Salud Carlos III through the Project PI13/00583 (co-funded by European Regional Development Fund/European Social Fund, “Investing in your future”) [PI13/00583]; Sociedad Española de Neumología y Cirugía Torácica (SEPAR) [ 166/2013 and 501/2017 ]; and the Center for Biomedical Research Network in Respiratory Diseases (CIBERES) [ CB06/06/0028 ].
Identification
Copyright
© 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
