title: Cardiovascular autonomic alterations in hospitalized patients with community-acquired pneumonia.
abstract: Alterations of cardiac autonomic control (CAC) are associated with poor outcomes in patients with infectious and non-infectious diseases. No evaluation of CAC in patients with community-acquired pneumonia (CAP) has been performed so far. The aim of the study was to assess CAC in patients with CAP and evaluate the impact of its alterations on disease severity and clinical outcomes in a multicenter, prospective, observational study.
  
  
  
  Consecutive patients hospitalized for CAP were enrolled between 2011 and 2013 two university hospitals in Italy. CAC was assessed by linear spectral and non-linear symbolic analysis of heart rate variability. The presence of severe CAP was evaluated on hospital admission. The primary study outcome was time to clinical stability (TCS) during hospitalization.
  
  
  
  Among the 75 patients enrolled (median age: 75 years; 57 % males), a significantly lower total variability and reduction of sympathetic rhythmical component with predominant respiratory modulation was detected in comparison to controls. Among CAP patients affected by a severe CAP on admission, CAC showed a lower sympathetic modulation and predominant parasympathetic oscillatory rhythm. At the multivariate analysis, variables independently correlated with a TCS >7 days were total power, as marker of total variability, [OR (95 % CI): 0.997 (0.994-1.000), p = 0.0454] and sympathetic modulation [OR (95 % CI): 0.964 (0.932-0.998), p = 0.0367].
  
  
  
  Loss of sympathetic rhythmical oscillation is associated with a more severe disease and worse early clinical outcome in hospitalized patients with CAP.
authors.affiliation: Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy. stefano.aliberti@unimi.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Aliberti
authors.affiliation: Departments of Internal Medicine, and Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Tobaldini
authors.affiliation: Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Giuliani
authors.affiliation: Departments of Internal Medicine, and Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Nunziata
authors.affiliation: Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Via Giovanni Battista Grassi 74, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Casazza
authors.affiliation: Health Science Department, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, Via Pergolesi 33, Monza, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Suigo
authors.affiliation: Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: D'Adda
authors.affiliation: Health Science Department, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, Via Pergolesi 33, Monza, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Bonaiti
authors.affiliation: Departments of Internal Medicine, and Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Roveda
authors.affiliation: Departments of Internal Medicine, and Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy.|Department of Physical Education, Federal University of Juiz de Fora, Minas Gerais, Brazil.
authors.forename: Andreia
authors.initials: A
authors.lastname: Queiroz
authors.affiliation: Department of Emergency Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy.
authors.forename: Valter
authors.initials: V
authors.lastname: Monzani
authors.affiliation: Health Science Department, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, Via Pergolesi 33, Monza, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pesci
authors.affiliation: Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Blasi
authors.affiliation: Departments of Internal Medicine, and Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Montano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001341:Autonomic Nervous System / Q000503:physiopathology*; D002319:Cardiovascular System / Q000503:physiopathology*; D017714:Community-Acquired Infections / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011014:Pneumonia / Q000503:physiopathology*; D011446:Prospective Studies
keywords: Cardiac autonomic control; Heart rate variability; Pneumonia; Spectral analysis; Symbolic analysis; Sympathetic