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J Infect. 2013 Jan;66(1):27-33. doi: 10.1016/j.jinf.2012.09.003. Epub 2012 Sep 11.

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

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  • 1Department of Infectious Diseases, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain. dfviasusp@unal.edu.co



To determine the risk factors and the prognosis of acute cardiac events in patients with community-acquired pneumonia (CAP).


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.


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).


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.

Copyright © 2012 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

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