Risk stratification and prognosis of acute cardiac events in hospitalized adults with community-acquired pneumonia

Objective: To determine the risk factors and the prognosis of acute cardiac events in patients with community-acquired pneumonia (CAP). Methods: Observational analysis of a prospective cohort of hospitalized adults with CAP (1995-2010). A logistic regression analysis was performed to identify predictors for acute cardiac events and mortality. Results: Of 3921 patients with CAP, 315 (8%) had one or more acute cardiac events during hospitalization (199 new-onset or worsening cardiac arrhythmias, 118 new-onset or worsening congestive heart failure and/or 30 myocardial infarction). In the multivariate analysis, factors associated with these events were age >65 years, chronic heart disease, chronic kidney disease, tachycardia, septic shock, multilobar pneumonia, hypoalbuminemia, and pneumococcal pneumonia. A rule based on these variables had an area under ROC curve of 0.73 (95% CI 0.70-0.76) to predict acute cardiac events. These complications occurred in 2.8% of patients classified in the low-risk (<= 3 points), 9.7% in the intermediate-risk (4-5 points) and 21.2% in the high-risk (>= 6 points) groups (P < .001). The overall case fatality rate was higher in patients who had acute cardiac events (19.4% vs. 6.4%; P < .001). Conclusion: Acute cardiac events occur frequently during hospitalization for CAP and are associated with poor prognosis. A simple rule based on demographic and clinical features may help identify patients at higher risk of these complications. (C) 2012 The British Infection Association. Published by Elsevier Ltd. All rights reserved.