Community-Acquired Pneumonia

Feldman, Charles; Anderson, Ronald

doi:10.1378/chest.15-0484

Cited by 46 publications

(21 citation statements)

References 62 publications

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“…The potential biological mechanism leading to HF or COPD progression following an acute pneumonia episode have not yet been precisely defined. Speculation that the inflammatory response is, in part, harmful underlies the current thinking as prior studies have identified inflammation as a risk factor for development of coronary artery disease [ 19 , 20 ]. In support of the role of inflammation, levels of interleukin 6 measured at the time of hospital discharge in patients with pneumonia identify patients at greater risk of cardiovascular related mortality within a one year follow-up [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…These data, if confirmed, suggest successful pneumonia prevention in cardiac and pulmonary disease patients could alter longer term outcomes. Alternatively, addressing the underlying mechanisms, such as chronic inflammation and/or platelet activation, could potentially alter the frequency of exacerbations of HF or COPD [ 20 ]. Smoking cessation and vaccination against influenza and pneumococcal disease are currently recommended for the prevention of CAP [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

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Risk of exacerbation following pneumonia in adults with heart failure or chronic obstructive pulmonary disease

et al. 2017

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BackgroundRecent evidence demonstrates increased short-term risk of cardiac complications and respiratory failure among patients with heart failure (HF) and chronic obstructive pulmonary disease (COPD), respectively, concurrent with an episode of community-acquired pneumonia (CAP). We evaluated patients with pre-existing HF or COPD, beginning 30 days after CAP diagnosis, to determine if CAP had a prolonged impact on their underlying comorbidity.MethodsA retrospective matched-cohort design using US healthcare claims was employed. In each month of accrual, patients with HF or COPD who developed CAP (“CAP patients”) were matched (1:1, without replacement, on demographic and clinical profiles) to patients with HF or COPD who did not develop CAP (“comparison patients”). All patients were aged ≥40 years, and were pneumonia free during prior 1-year period. Exacerbation beginning 30 days after the CAP diagnosis and for the subsequent 1-year period were compared between CAP and comparison patients.Findings38,010 (4·6%) HF patients and 48,703 (5·9%) COPD patients experienced a new CAP episode requiring hospitalization or outpatient care only, and were matched to comparison patients. In the HF subset, CAP patients were 47·2% more likely to experience an exacerbation vs patients without CAP (17·8% vs. 12·1%; p<0·001); in the COPD subset, CAP patients were 42·3% more likely to experience an exacerbation (16·2% vs. 11·4%; p<0·001).ConclusionsOur data provide evidence that CAP foreshadows a prolonged increase in risk of exacerbation of underlying HF or COPD in adults, and suggests a potential benefit to CAP prevention strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk of exacerbation following pneumonia in adults with heart failure or chronic obstructive pulmonary disease

et al. 2017

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“…In this setting, activated platelets act as bridges promoting neutrophil clusters, as well as binding of neutrophils to vascular endothelium mediated by CD62P and other pro-adhesive mechanisms [30, 32, 42]. If poorly controlled, systemic inflammatory mechanisms involving platelets, neutrophils and vascular endothelium predispose to endothelial damage and dysfunction, promoting microvascular damage and coagulation [31]. …”

Section: Pathogenic Mechanisms Of Cap-associated Cvesmentioning

confidence: 99%

“…These have been covered extensively in recent reviews [31, 48] and will be considered briefly here. Agents which target platelet activation fall into several categories, targeting both mediators of activation and their receptors, and include, but are not limited to, the following:

inhibitors of production of thromboxane A 2

antagonists of thromboxane A 2 receptors

antagonists of ADP-activated P2Y12 receptors

antagonists of thrombin-activated proteinase-activated receptor 1

GPIIb/IIIa inhibitors.

…”

Section: Treatment And/or Prevention Of Cap-associated Cvesmentioning

confidence: 99%

“…Apart from protecting isolated human brain microvascular endothelial cells [63] and airway epithelial cells [64] against the cytotoxic actions of pneumolysin, simvastatin has also been found to reduce mortality in a murine sickle-cell disease model of experimental pneumococcal infection [63]. While these activities of simvastatin appear to be related to interference with pneumolysin/membrane cholesterol interactions, it is also noteworthy that statins possess alternative anti-inflammatory activity unrelated to their membrane cholesterol-lowering activities that target various inflammatory cell types, including platelets [31]. …”

Section: Treatment And/or Prevention Of Cap-associated Cvesmentioning

confidence: 99%

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Prevalence, pathogenesis, therapy, and prevention of cardiovascular events in patients with community-acquired pneumonia

Feldman

Anderson

2016

pneumonia

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It is now well recognised that cardiac events occur relatively commonly in patients with acute community-acquired pneumonia. While these events are more frequent in patients with underlying risk factors—such as those with underlying chronic cardiovascular and respiratory comorbidities, the elderly, and in nursing home residents—they also occur in patients with no underlying risks other than severe pneumonia. Recent research elucidating the underlying pathogenic mechanisms related to these cardiac events has indicated a probable role for platelet activation, which is possibly exacerbated by pneumolysin in the case of pneumococcal infections. This, in turn, has resulted in the identification of possible therapeutic strategies targeting platelet activation, as well as the cardio-toxic activity of pneumolysin. These issues represent the primary focus of the current review.

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The Intensive Care Global Study on Severe Acute Respiratory Infection (IC-GLOSSARI): a multicenter, multinational, 14-day inception cohort study

Sakr¹,

Ferrer

Reinhart³

et al. 2016

Intensive Care Med

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Purpose: In this prospective, multicenter, 14-day inception cohort study, we investigated the epidemiology, patterns of infections, and outcome in patients admitted to the intensive care unit (ICU) as a result of severe acute respiratory infections (SARIs). Methods:All patients admitted to one of 206 participating ICUs during two study weeks, one in November 2013 and the other in January 2014, were screened. SARI was defined as possible, probable, or microbiologically confirmed respiratory tract infection with recent onset dyspnea and/or fever. The primary outcome parameter was in-hospital mortality within 60 days of admission to the ICU. Results:Among the 5550 patients admitted during the study periods, 663 (11.9 %) had SARI. On admission to the ICU, Gram-positive and Gram-negative bacteria were found in 29.6 and 26.2 % of SARI patients but rarely atypical bacteria (1.0 %); viruses were present in 7.7 % of patients. Organ failure occurred in 74.7 % of patients in the ICU, mostly respiratory (53.8 %), cardiovascular (44.5 %), and renal (44.6 %). ICU and in-hospital mortality rates in patients with SARI were 20.2 and 27.2 %, respectively. In multivariable analysis, older age, greater severity scores at ICU admission, and hematologic malignancy or liver disease were independently associated with an increased risk of in-hospital death, whereas influenza vaccination prior to ICU admission and adequate antibiotic administration on ICU admission were associated with a lower risk.*Correspondence: yasser.sakr@med.uni-jena.de 1 Department of Anesthesiology and Intensive Care, Uniklinikum Jena, Erlanger Allee 103, 07743 Jena, Germany Full list of author information is available at the end of the article Take-home message: Admission to the ICU for SARI is common and associated with high morbidity and mortality rates. We identified several risk factors for in-hospital death that may be useful for risk stratification in these patients.On behalf of the IC-GLOSSARI Investigators and the Trials Group of the European Society of Intensive Care (ESICM), Rue Belliard, 19, 1040 Brussels, Belgium. Email: research@esicm.org.A complete list of IC-GLOSSARI investigators is provided in the "Appendix". Conclusions:Admission to the ICU for SARI is common and associated with high morbidity and mortality rates. We identified several risk factors for in-hospital death that may be useful for risk stratification in these patients.

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Community-Acquired Pneumonia

Cited by 46 publications

References 62 publications

Risk of exacerbation following pneumonia in adults with heart failure or chronic obstructive pulmonary disease

Risk of exacerbation following pneumonia in adults with heart failure or chronic obstructive pulmonary disease

Prevalence, pathogenesis, therapy, and prevention of cardiovascular events in patients with community-acquired pneumonia

The Intensive Care Global Study on Severe Acute Respiratory Infection (IC-GLOSSARI): a multicenter, multinational, 14-day inception cohort study

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