Complications of Cardiovascular Events in Patients Hospitalized with Influenza-Related Pneumonia

Abstract

Purpose: Influenza virus infections are a key cause of community-acquired pneumonia (CAP). Cardiovascular events (CVEs) are common among CAP and influenza patients, but there have been few population-based studies of influenza-related pneumonia (Flu-p) patients published to date. Methods: A retrospective analysis of 1191 immunocompetent hospitalized adult Flu-p patients from January 2012 to December 2018 in five teaching hospitals in China was conducted. Results: A total of 24.6% (293/1191) of patients developed at least one form of CVE-related complication while hospitalized. In a multivariate logistic regression analysis, hypertension, cerebrovascular disease, coronary artery disease, preexisting heart failure, systolic blood pressure <90 mmHg, respiratory rates ≥30 breaths/min, a lymphocyte count <0.8×10 9 /L, PaO 2 /FiO 2 <300 mmHg, and systemic corticosteroid administration were independently associated with the incidence of CVEs; while early neuraminidase inhibitor treatment and angiotensin converting enzyme inhibitors/angiotensin II receptor blocker treatment were associated with a lower risk of CVEs. After controlling for potential confounding variables, we determined that CVEs were linked to a higher risk of 30-day mortality (OR 3.307,, p < 0.001) in Flu-p patients. Conclusion: CVE-related complications are common among hospitalized Flu-p patients and are associated with negative patient outcomes. Clarifying these CVE-related risk factors can aid in their clinical prevention and management.

Cumulative incidence and mortality rate of cardiovascular complications due to laboratory‐confirmed influenza virus infection: A systematic review and meta‐analysis

“…For the analysis of our primary outcome, we retrieved 19 studies (study schema detailed in Figure 1). Specifically, we found 18 observational studies (13 retrospective [38][39][40][41][42][43][44][45][46][47][48][49][50] and 5 prospective [51][52][53][54][55] ) and 1 RCT. 56 Table 1 shows the baseline characteristics of the studies used to evaluate our primary outcome.…”

“…According to the Köppen‐Geiger climate classification, 12 studies 38,43–51,54,55 were conducted in locations whose climate was designated as temperate, 2 studies 40,53 were conducted in a location with cold climate, 1 study 52 in a location with a tropical climate, 1 study 39 in a location with an arid climate, and 3 studies 41,42,56 were conducted in multiple sites with varying climate designations. The pooled cumulative incidence of HF was 1.72% (95% CI: 1.02%–2.57%) in two studies 43,47 with temperate climate, 17.39% (95% CI: 6.98%–37.14%) in one study 40 with cold climate, and 54.05% (95% CI: 38.38%–68.96%) in one study 52 with tropical climate (Supplementary Figure ).…”

“…Of the total 4010 patients with influenza‐related cardiovascular complications from the 13 studies included, 162 (4.0%) patients died 38,41,43,45–48,50,51,53–56 . The in‐hospital mortality rate from any cardiovascular complication was 1.38% (95% CI: 0.00%–4.80%).…”

“…The study of Chen et al. included the majority of patients with this outcome of interest (96.3%) but did not specify the type of arrhythmia 41 . The H1N1 strain was documented in 7 of the 214 (3.3%) patients with arrhythmia (Figure 3).…”

“…Of the total 4794 patients with influenza from the 6 studies included, 135 (2.8%) patients were diagnosed with AMI. 41,43,44,49,50,54 The cumulative incidence of AMI was 2.19% (95% CI: 1.03%-3.72%). The H1N1 strain was documented in 12 of the 135 (8.8%) patients with AMI (Figure 5).…”