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Introduction Community-acquired pneumonia increases the risk of cardiovascular events (CVE). The objective of this study was to analyze host, severity, and etiology factors associated with the appearance of early and late events and their impact on mortality. Method Prospective multicenter cohort study in patients hospitalized for pneumonia. CVE and mortality rates were collected at admission, 30-day follow-up (early events), and one-year follow-up (late events). Results In total, 202 of 1967 (10.42%) patients presented early CVE and 122 (6.64%) late events; 16% of 1-year mortality was attributed to cardiovascular disease. The host risk factors related to cardiovascular complications were: age ≥ 65 years, smoking, and chronic heart disease. Alcohol abuse was a risk factor for early events, whereas obesity, hypertension, and chronic renal failure were related to late events. Severe sepsis and Pneumonia Severity Index (PSI) ≥ 3 were independent risk factors for early events, and only PSI ≥ 3 for late events. Streptococcus pneumoniae was the microorganism associated with most cardiovascular complications. Developing CVE was an independent factor related to early (OR 2.37) and late mortality (OR 4.05). Conclusions Age, smoking, chronic heart disease, initial severity, and S. pneumoniae infection are risk factors for early and late events, complications that have been related with an increase of the mortality risk during and after the pneumonia episode. Awareness of these factors can help us make active and early diagnoses of CVE in hospitalized CAP patients and design future interventional studies to reduce cardiovascular risk.

Resumen Introduccion La neumonia adquirida en la comunidad se asocia al desarrollo de eventos cardiovasculares (ECV). El objetivo del estudio fue analizar los factores relativos al huesped, la gravedad y la etiologia que se asocian con la aparicion de estos eventos, tempranos y tardios, y su impacto en la mortalidad. Metodo Estudio prospectivo de cohortes multicentrico en pacientes ingresados por neumonia. Se recogieron ECV durante el ingreso, a los 30 dias (tempranos) y al ano (tardios) y la mortalidad. Resultados Doscientos dos de 1.967 (10,42%) pacientes presentaron ECV tempranos y 122 (6,64%) tardios. El 16% de la mortalidad al ano se atribuyo a complicaciones cardiovasculares. Los factores del huesped relacionados con complicaciones cardiovasculares fueron: edad ≥ 65 anos, abuso de alcohol, tabaquismo y cardiopatia cronica en los tempranos y obesidad, HTA e insuficiencia renal cronica en los tardios. La presencia de sepsis grave y Pneumonia Severity Index (PSI) ≥ 3 fueron factores de riesgo independiente de eventos tempranos y, unicamente, el PSI ≥ 3 de los tardios. Streptococcus pneumoniae fue el microorganismo con mayor riesgo de complicaciones cardiovasculares. Desarrollar un ECV fue factor independiente de mortalidad temprana (OR 2,37) y tardia (OR 4,05). Conclusiones La edad, el tabaquismo, la cardiopatia, la gravedad inicial y el S. pneumoniae son factores de riesgo de presentar ECV tempranos y tardios, lo que conlleva mayor mortalidad durante y tras el episodio agudo de neumonia. Conocer estos factores puede ser de utilidad para desarrollar estrategias activas de diagnostico precoz de eventos y/o disenar ensayos dirigidos a reducir las complicaciones cardiovasculares.

Introduction: High-flow therapy (HFT) has changed the activity in RICU. The purpose of this analysis is to find out the indications of HFT in our unit compared to non-invasive mechanical ventilation. Methods: Patients admitted in 2019 were prospectively registered. Epidemiological data were collected, admission reason, respiratory support treatment, unit of origin, and overall mortality, upon admission and within 30 days of discharge from the unit. SPSS was used for statistical analysis. Results: 199 patients (mean age 63). 70 (35%) women. Average stay 7.5 days. They came from: emergency departments (42.2%), ICU (21.6%) other hospitals (14.1%), pneumology (6%), haematological (5.5%). 36.7% were initially classified do-not-intubate patient. Mortality was 12.2% with increase of 19.5% during 30 days follow-up. According to whether or not you were an intubation candidate was 9.65% and 35.7%. Hypoxemic respiratory failure was main admission reason. Followed by respiratory hypercapnic failure. Fig 1. Respiratory supports due to reason are showed at Fig 2. Conclusions: Hypoxemic respiratory failure is the main reason for admission. NIV and OAF are equaly used in RICU but differently due to on reason of admission.

Introduction: Many departments in Europe treat patients with severe respiratory diseases in the respiratory intermediate care units (RICUs). Non-invasive mechanical ventilation (NIV) and high flow nasal cannula (HFNC) are the cornestone of the treatments prescribed. The aim of the present study was to describe the 7 months activity of our unit and compare the use of NIV vs HFNC. Methods: A systematic record of activity carried out between January and July 2019 was kept prospectively. The main variables were demographics, clinical data, respiratory support methods, and in-hospital mortality. Results: Of 112 patients with a mean age of 63 years admitted to the unit, 41 had do-not-intubate (DNI) orders. 41% came from the emergency department, 27% from the intensive care unit (ICU), 32% from others services. Severe hypoxemic failure (43.8%) was the main respiratory indication, respiratory acidosis was the second (24.1%) (fig1). 30.3% required NIV, 30,3% required HFNC, 12,5% alternated both systems. Rest data showed in fig2. Median length of stay was 4 days. 67% of patients were discharged to the respiratory ward; 15.3% to other wards, 2.7% required subsequent admission to the ICU, 15% died. Conclusions: In this sample, we highlight the role of HFNC that nearly equals the indications for NIV

Community-acquired pneumonia (CAP) remains the first cause of morbidity and mortality worldwide due to infection. Several aspects such as severity and host response are related to its clinical course and outcome. Beyond the acute implications that the infection provokes in the host, pneumonia also has long-term negative consequences. Among them, cardiovascular complications and mortality are the most outstanding. Therefore, an adequate recognition and stratification of the risk of complications and mortality is crucial. Many biomarkers have been studied for these reasons, considering that each biomarker mirrors a different aspect. Moreover, the clinical application of many of them is still being deliberated because of their limitations and the heterogeneity of the disease. In this review, we examine some of the most relevant biomarkers that we have classified as cardiac and non-cardiac. We discuss some classic biomarkers and others that are considered novel biomarkers, which are mainly involved in cardiovascular risk.

Background Community-acquired pneumonia (CAP) increases the risk of cardiovascular complications during and following the episode. The goal of this study was to determine the usefulness of cardiovascular and inflammatory biomarkers for assessing the risk of early (within 30 days) or long-term (1-year follow-up) cardiovascular events. Methods A total of 730 hospitalized patients with CAP were prospectively followed up during 1 year. Cardiovascular (proadrenomedullin [proADM], pro-B-type natriuretic peptide (proBNP), proendothelin-1, and troponin T) and inflammatory (interleukin 6 [IL-6], C-reactive protein, and procalcitonin) biomarkers were measured on day 1, at day 4/5, and at day 30. Results Ninety-two patients developed an early event, and 67 developed a long-term event. Significantly higher initial levels of proADM, proendothelin-1, troponin, proBNP, and IL-6 were recorded in patients who developed cardiovascular events. Despite a decrease at day 4/5, levels remained steady until day 30 in those who developed late events. Biomarkers (days 1 and 30) independently predicted cardiovascular events adjusted for age, previous cardiac disease, Pa o 2/F io 2 Conclusions Cardiac biomarkers are useful for identifying patients with CAP at high risk for early and long-term cardiovascular events. They may aid personalized treatment optimization and for designing future interventional studies to reduce cardiovascular risk.

Introduction: Community-acquired pneumonia (CAP) increases the risk of cardiovascular (CV) events. Aim: To study the occurrence of CV events in patients with CAP and their link with biomarkers. Method: Prospective study in a Spanish hospital in 572 patients with CAP followed for 1 year. We collected comorbidities, CV events (from admission to 1 year) and biomarkers: proBNP, troponins (TnT), endothelin, proadrenomedullin (proADM), procalcitonin (PCT). We performed ROC curve of biomarkers for CV events. Results: We studied 322 patients with biomarkers; 65 (20.2%) had CV events (39 after discharge). Biomarkers are shown in table1. The areas under the ROC curve (AUC) of biomarkers day 1 for CV events: TnT 0.77(95%CI 0.71-0.84), proBNP 0.77(0.70-0.84), endothelin 0.70(0.61-0.80), proADM 0.70(0.60-0.79), PCT 0.56(0.46-0.66). The AUC of day 4: proADM 0.77(0.70-0.85), endothelin 0.75(0.67-0.83), proBNP 0.75(0.67-0.82), TnT 0.75(0.68-0.82), PCT 0.56(0.47-0.66). Conclusions: Biomarkers may predict early and long-term CV events in CAP. TnT and proBNP during the 1st day and proADM the 4th day are the best biomarkers predicting CV events. | | No cardiovascular events | Cardiovascular events | P value | || | ProADM day 1 | 0.9 (0.7-1.2) | 1.5 (1.0-2.1) | 0.000 | | ProADM day 4 | 0.8 (0.6-0.9) | 1.2 (0.9-1.6) | 0.000 | | PCT day 1 | 0.3 (0.1-1.7) | 0.7 (0.2-3.4) | 0.035 | | PCT day 4 | 0.1 (0.0-0.4) | 0.2 (0.1-0.5) | 0.123 | | Endothelin day 1 | 79.4 (54.7-117.9) | 143.3 (96.6-188.9) | 0.000 | | Endothelin day 4 | 62.4 (47.0-79.7) | 93.5 (78.4-129.7) | 0.000 | | TnT day 1 | 11.1 (4.3-21.6) | 28.1 (15.9-47.8) | 0.000 | | TnT day 4 | 10.3 (4.7-21.3) | 23.2 (15.8-50.0) | 0.000 | | ProBNP day 1 | 553.9 (177.6-1559.0) | 2465.0 (1006.0-6523.0) | 0.000 | | ProBNP day 4 | 385.5 (113.5-1405.0) | 2059.0 (681.7-3926.0) | 0.000 | * Data presented as median (Q1-Q3) Cardiovascular and inflammatory biomarkers