Prognostic Factors for Cardiovascular Events in Elderly Patients with Community Acquired Pneumonia: Results from the CAP-China Network

BACKGROUND: Limited data were available about the burden of cardiovascular events (CVEs) during hospitalization in elderly patients with community-acquired pneumonia (CAP). The aim was to assess the incidence, characteristics, predictive factors and outcomes of CVEs in elderly patients with CAP during hospitalization. METHODS: This study was a multicenter, retrospective research on hospitalized elderly patients with CAP from the CAP-China network. Predictive factors for the occurrence of CVEs and 30-day mortality were identified by multivariable logistic regression analysis. RESULTS: Of 2941 hospitalized elderly patients, 402 (13.7%) developed CVEs during hospitalization with the median age of 81 years old. Compared with non-CVEs patients, patients with CVEs were older, more comorbidities, and higher disease severity; use of glucocorticoids, leukocytosis, azotemia, hyponatremia, multilobe infiltration and pleural effusion were more common; the rate of clinical failure (CF), in-hospital mortality and 30-day mortality were higher, which significantly increased with age and the number of CVEs (p < 0.001). Multivariable logistic regression showed previous history of congestive heart failure (odds ratio [OR], 6.16; 95% CI, 4.14–9.18), CF (OR, 4.69; 95% CI, 3.392–6.48), previous history of ischemic heart disease (OR, 2.22; 95% CI, 1.61–3.07), use of glucocorticoids (OR, 2.0; 95% CI, 1.39–2.89), aspiration (OR, 1.88; 95% CI, 1.26–2.81), pleural effusion (OR, 1.66; 95% CI, 1.25–2.20), multilobe infiltration (OR, 1.50; 95% CI, 1.15–1.96), age (OR, 1.05; 95% CI, 1.04–1.07), and blood urea nitrogen (OR, 1.03; 95% CI, 1.01–1.06) were independent predictors for the occurrence of CVEs, while level of blood sodium (OR, 0.98; 95% CI, 0.97–0.99) was protective factor. Renal failure (OR, 9.46; 95% CI, 4.17–21.48), respiratory failure (OR, 9.32; 95% CI, 5.91–14.71), sepsis/septic shock (OR, 7.87; 95% CI, 3.58–17.31), new cerebrovascular diseases (OR, 5.94; 95% CI, 1.78–19.87), new heart failure (OR, 4.04; 95% CI, 1.15–14.14), new arrhythmia (OR, 2.38; 95% CI, 1.11–5.14), aspiration (OR, 1.95; 95% CI, 1.09–3.50), CURB-65 (OR, 1.57; 95% CI, 1.21–2.02), and white blood cell count (OR, 1.05; 95% CI, 1.02–1.09) were independent predictors for 30-day mortality in elderly patients with CAP, while lymphocyte count (OR, 0.63; 95% CI, 0.46–0.87) was protective factor. CONCLUSION: Patients with CVEs had heavier disease burden and worse prognosis. Early recognition of risk factors is meaningful to strengthen the management in elderly patients with CAP.