title: Risk stratification and prognosis of acute cardiac events in hospitalized adults with community-acquired pneumonia.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Infectious Diseases, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain. dfviasusp@unal.edu.co
authors.forename: Diego
authors.initials: D
authors.lastname: Viasus
authors.forename: Carolina
authors.initials: C
authors.lastname: Garcia-Vidal
authors.forename: Frederic
authors.initials: F
authors.lastname: Manresa
authors.forename: Jordi
authors.initials: J
authors.lastname: Dorca
authors.forename: Francesc
authors.initials: F
authors.lastname: Gudiol
authors.forename: Jordi
authors.initials: J
authors.lastname: Carratalà
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000453:epidemiology* / Q000382:microbiology; D017714:Community-Acquired Infections / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000382:microbiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications / Q000453:epidemiology*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome