Subscribe to RSS
DOI: 10.1055/s-0036-1593754
Complication of Community-Acquired Pneumonia (Including Cardiac Complications)
Publication History
Publication Date:
13 December 2016 (online)
![](https://www.thieme-connect.de/media/srccm/201606/lookinside/thumbnails/10-1055-s-0036-1593754_01250-1.jpg)
Abstract
Community-acquired pneumonia (CAP) represents an important public health problem and carries significant morbidity, mortality, and costs. The incidence of CAP is highest among children and elderly patients, but the mortality is much higher in patients older than 65 years. Despite the advances in medicine, the administration of antimicrobials, and the overall better care, there are still patients with CAP dying due to systemic complications all over the world. A continuum of CAP disease progression may involve multiple organs beyond the pulmonary parenchyma. These pulmonary and nonpulmonary complications are associated not only with mortality but also with the development of clinical failure, prolonged hospitalization, and the need for more intensive level of care. In this review, we present the characteristics of several CAP-related pulmonary and nonpulmonary organ dysfunction, such as those affecting the heart, kidneys, hematological, neurological, endocrine systems. Multiple severity of illness scores identified a series of systemic findings that indicate the organ dysfunctions and the associated related outcomes. However, further research is required to address the mechanisms, the management, and prevention of organ dysfunction in patients with CAP.
-
References
- 1 Murphy SL, Xu J, Kochanek KD. Deaths: final data for 2010. Natl Vital Stat Rep 2013; 61 (4) 1-117
- 2 Kochanek KD, Murphy SL, Xu J, Arias E. Mortality in the United States, 2013. NCHS Data Brief 2014; (178) 1-8
- 3 Wunderink RG, Waterer GW. Clinical practice. Community-acquired pneumonia. N Engl J Med 2014; 370 (6) 543-551
- 4 Restrepo MI, Anzueto A. Severe community-acquired pneumonia. Infect Dis Clin North Am 2009; 23 (3) 503-520
- 5 World Health Organization. The Top 10 Causes of Death. Geneva; 2013
- 6 Sibila O, Meduri GU, Mortensen EM , et al. Improving the 2007 Infectious Disease Society of America/American Thoracic Society severe community-acquired pneumonia criteria to predict intensive care unit admission. J Crit Care 2013; 28 (3) 284-290
- 7 Fernandez JF, Sibila O, Restrepo MI. Predicting ICU admission in community-acquired pneumonia: clinical scores and biomarkers. Expert Rev Clin Pharmacol 2012; 5 (4) 445-458
- 8 Restrepo MI, Bienen T, Mortensen EM , et al; Chest Infections Network. Evaluation of ICU admission criteria and diagnostic methods for patients with severe community-acquired pneumonia: current practice survey. Chest 2008; 133 (3) 828-829
- 9 Prina E, Ranzani OT, Torres A. Community-acquired pneumonia. Lancet 2015; 386 (9998) 1097-1108
- 10 Kojicic M, Li G, Hanson AC , et al. Risk factors for the development of acute lung injury in patients with infectious pneumonia. Crit Care 2012; 16 (2) R46
- 11 Cillóniz C, Ewig S, Polverino E , et al. Pulmonary complications of pneumococcal community-acquired pneumonia: incidence, predictors, and outcomes. Clin Microbiol Infect 2012; 18 (11) 1134-1142
- 12 Sanz F, Restrepo MI, Fernández-Fabrellas E , et al. Does prolonged onset of symptoms have a prognostic significance in community-acquired pneumonia?. Respirology 2014; 19 (7) 1073-1079
- 13 Aliberti S, Brambilla AM, Chalmers JD , et al. Phenotyping community-acquired pneumonia according to the presence of acute respiratory failure and severe sepsis. Respir Res 2014; 15: 27
- 14 Aliberti S, Amir A, Peyrani P , et al. Incidence, etiology, timing, and risk factors for clinical failure in hospitalized patients with community-acquired pneumonia. Chest 2008; 134 (5) 955-962
- 15 Smith MW, Schmidt JE, Rehg JE, Orihuela CJ, McCullers JA. Induction of pro- and anti-inflammatory molecules in a mouse model of pneumococcal pneumonia after influenza. Comp Med 2007; 57 (1) 82-89
- 16 Houck PM, Bratzler DW, Nsa W, Ma A, Bartlett JG. Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med 2004; 164 (6) 637-644
- 17 Sibila O, Restrepo MI, Anzueto A. What is the best antimicrobial treatment for severe community-acquired pneumonia (including the role of steroids and statins and other immunomodulatory agents). Infect Dis Clin North Am 2013; 27 (1) 133-147
- 18 Jain S, Self WH, Wunderink RG , et al; CDC EPIC Study Team. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med 2015; 373 (5) 415-427
- 19 Musher DM, Thorner AR. Community-acquired pneumonia. N Engl J Med 2014; 371 (17) 1619-1628
- 20 Chalmers JD, Singanayagam A, Murray MP, Scally C, Fawzi A, Hill AT. Risk factors for complicated parapneumonic effusion and empyema on presentation to hospital with community-acquired pneumonia. Thorax 2009; 64 (7) 592-597
- 21 Ahmed RA, Marrie TJ, Huang JQ. Thoracic empyema in patients with community-acquired pneumonia. Am J Med 2006; 119 (10) 877-883
- 22 Tsang KY, Leung WS, Chan VL, Lin AW, Chu CM. Complicated parapneumonic effusion and empyema thoracis: microbiology and predictors of adverse outcomes. Hong Kong Med J 2007; 13 (3) 178-186
- 23 Emamian SA, Kaasbol MA, Olsen JF, Pedersen JF. Accuracy of the diagnosis of pleural effusion on supine chest X-ray. Eur Radiol 1997; 7 (1) 57-60
- 24 Porcel JM, Light RW. Diagnostic approach to pleural effusion in adults. Am Fam Physician 2006; 73 (7) 1211-1220
- 25 Soni NJ, Franco R, Velez MI , et al. Ultrasound in the diagnosis and management of pleural effusions. J Hosp Med 2015; 10 (12) 811-816
- 26 Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest 2015; 147 (6) 1659-1670
- 27 Reissig A, Copetti R, Mathis G , et al. Lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia: a prospective, multicenter, diagnostic accuracy study. Chest 2012; 142 (4) 965-972
- 28 Rodríguez Suárez P, Freixinet Gilart J, Hernández Pérez JM, Hussein Serhal M, López Artalejo A. Treatment of complicated parapneumonic pleural effusion and pleural parapneumonic empyema. Med Sci Monit 2012; 18 (7) CR443-CR449
- 29 Nie Y, Li C, Zhang J , et al. Clinical application of high-resolution computed tomographic imaging features of community-acquired pneumonia. Med Sci Monit 2016; 22: 1053-1061
- 30 Mandell LA, Wunderink RG, Anzueto A , et al; Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44 (Suppl. 02) S27-S72
- 31 Potgieter PD, Hammond JM, Musson G, Odell J. Surgical drainage of lung abscess complicating acute community-acquired pneumonia. Chest 1991; 99 (5) 1280-1282
- 32 Vardakas KZ, Matthaiou DK, Falagas ME. Comparison of community-acquired pneumonia due to methicillin-resistant and methicillin-susceptible Staphylococcus aureus producing the Panton-Valentine leukocidin. Int J Tuberc Lung Dis 2009; 13 (12) 1476-1485
- 33 Löffler B, Niemann S, Ehrhardt C , et al. Pathogenesis of Staphylococcus aureus necrotizing pneumonia: the role of PVL and an influenza coinfection. Expert Rev Anti Infect Ther 2013; 11 (10) 1041-1051
- 34 Sanz F, Restrepo MI, Fernández E , et al; NAC-CV Study Group. Is it possible to predict which patients with mild pneumonias will develop hypoxemia?. Respir Med 2009; 103 (12) 1871-1877
- 35 Ewig S, Torres A, Woodhead M. Assessment of pneumonia severity: a European perspective. Eur Respir J 2006; 27 (1) 6-8
- 36 Rello J, Rodriguez A, Lisboa T, Gallego M, Lujan M, Wunderink R. PIRO score for community-acquired pneumonia: a new prediction rule for assessment of severity in intensive care unit patients with community-acquired pneumonia. Crit Care Med 2009; 37 (2) 456-462
- 37 Rello J, Rodriguez A. Severity of illness assessment for managing community-acquired pneumonia. Intensive Care Med 2007; 33 (12) 2043-2044
- 38 Corrales-Medina VF, Alvarez KN, Weissfeld LA , et al. Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease. JAMA 2015; 313 (3) 264-274
- 39 Corrales-Medina VF, Taljaard M, Yende S , et al. Intermediate and long-term risk of new-onset heart failure after hospitalization for pneumonia in elderly adults. Am Heart J 2015; 170 (2) 306-312
- 40 Soto-Gomez N, Anzueto A, Waterer GW, Restrepo MI, Mortensen EM. Pneumonia: an arrhythmogenic disease?. Am J Med 2013; 126 (1) 43-48
- 41 Corrales-Medina VF, Musher DM, Shachkina S, Chirinos JA. Acute pneumonia and the cardiovascular system. Lancet 2013; 381 (9865) 496-505
- 42 Singanayagam A, Singanayagam A, Elder DH, Chalmers JD. Is community-acquired pneumonia an independent risk factor for cardiovascular disease?. Eur Respir J 2012; 39 (1) 187-196
- 43 Rae N, Finch S, Chalmers JD. Cardiovascular disease as a complication of community-acquired pneumonia. Curr Opin Pulm Med 2016; 22 (3) 212-218
- 44 Corrales-Medina VF, Taljaard M, Fine MJ , et al. Risk stratification for cardiac complications in patients hospitalized for community-acquired pneumonia. Mayo Clin Proc 2014; 89 (1) 60-68
- 45 Musher DM, Rueda AM, Kaka AS, Mapara SM. The association between pneumococcal pneumonia and acute cardiac events. Clin Infect Dis 2007; 45 (2) 158-165
- 46 Corrales-Medina VF, Suh KN, Rose G , et al. Cardiac complications in patients with community-acquired pneumonia: a systematic review and meta-analysis of observational studies. PLoS Med 2011; 8 (6) e1001048
- 47 Aliberti S, Ramirez JA. Cardiac diseases complicating community-acquired pneumonia. Curr Opin Infect Dis 2014; 27 (3) 295-301
- 48 Ponce NE, Cano RC, Carrera-Silva EA, Lima AP, Gea S, Aoki MP. Toll-like receptor-2 and interleukin-6 mediate cardiomyocyte protection from apoptosis during Trypanosoma cruzi murine infection. Med Microbiol Immunol (Berl) 2012; 201 (2) 145-155
- 49 Brown AO, Mann B, Gao G , et al. Streptococcus pneumoniae translocates into the myocardium and forms unique microlesions that disrupt cardiac function. PLoS Pathog 2014; 10 (9) e1004383
- 50 Brown AO, Millett ER, Quint JK, Orihuela CJ. Cardiotoxicity during invasive pneumococcal disease. Am J Respir Crit Care Med 2015; 191 (7) 739-745
- 51 González-Juarbe N, Gilley RP, Hinojosa CA , et al. Pore-forming toxins induce macrophage necroptosis during acute bacterial pneumonia. PLoS Pathog 2015; 11 (12) e1005337
- 52 Brown AO, Orihuela CJ. Visualization of Streptococcus pneumoniae within cardiac microlesions and subsequent cardiac remodeling. J Vis Exp 2015; (98)
- 53 Orihuela CJ, Gao G, Francis KP, Yu J, Tuomanen EI. Tissue-specific contributions of pneumococcal virulence factors to pathogenesis. J Infect Dis 2004; 190 (9) 1661-1669
- 54 Alhamdi Y, Neill DR, Abrams ST , et al. Circulating pneumolysin is a potent inducer of cardiac injury during pneumococcal infection. PLoS Pathog 2015; 11 (5) e1004836
- 55 Maciejewski P, Bednarz B, Chamiec T, Górecki A, Łukaszewicz R, Ceremuzyński L. Acute coronary syndrome: potassium, magnesium and cardiac arrhythmia. Kardiol Pol 2003; 59 (11) 402-407
- 56 Blasi F, Tarsia P, Aliberti S, Cosentini R, Allegra L. Chlamydia pneumoniae and Mycoplasma pneumoniae . Semin Respir Crit Care Med 2005; 26 (6) 617-624
- 57 Pigarevskii PV, Mal'tseva SV, Snegova VA, Davydova NG, Guseva VA. Chlamydia pneumoniae and immunoinflammatory reactions in an unstable atherosclerotic plaque in humans. Bull Exp Biol Med 2015; 159 (2) 278-281
- 58 Mortensen EM, Halm EA, Pugh MJ , et al. Association of azithromycin with mortality and cardiovascular events among older patients hospitalized with pneumonia. JAMA 2014; 311 (21) 2199-2208
- 59 Paddock CD, Liu L, Denison AM , et al. Myocardial injury and bacterial pneumonia contribute to the pathogenesis of fatal influenza B virus infection. J Infect Dis 2012; 205 (6) 895-905
- 60 Chalmers JD, Short PM, Mandal P, Akram AR, Hill AT. Statins in community acquired pneumonia: evidence from experimental and clinical studies. Respir Med 2010; 104 (8) 1081-1091
- 61 Mortensen EM, Nakashima B, Cornell J , et al. Population-based study of statins, angiotensin II receptor blockers, and angiotensin-converting enzyme inhibitors on pneumonia-related outcomes. Clin Infect Dis 2012; 55 (11) 1466-1473
- 62 Oz F, Gul S, Kaya MG , et al. Does aspirin use prevent acute coronary syndrome in patients with pneumonia: multicenter prospective randomized trial. Coron Artery Dis 2013; 24 (3) 231-237
- 63 Akram AR, Singanayagam A, Choudhury G, Mandal P, Chalmers JD, Hill AT. Incidence and prognostic implications of acute kidney injury on admission in patients with community-acquired pneumonia. Chest 2010; 138 (4) 825-832
- 64 Tate JA, Snitz BE, Alvarez KA , et al; GEM Study Investigators. Infection hospitalization increases risk of dementia in the elderly. Crit Care Med 2014; 42 (5) 1037-1046
- 65 Bo M, Massaia M, Raspo S , et al. Predictive factors of in-hospital mortality in older patients admitted to a medical intensive care unit. J Am Geriatr Soc 2003; 51 (4) 529-533
- 66 Pieralli F, Vannucchi V, Mancini A , et al. Delirium is a predictor of in-hospital mortality in elderly patients with community acquired pneumonia. Intern Emerg Med 2014; 9 (2) 195-200
- 67 Shah FA, Pike F, Alvarez K , et al. Bidirectional relationship between cognitive function and pneumonia. Am J Respir Crit Care Med 2013; 188 (5) 586-592
- 68 Fine MJ, Auble TE, Yealy DM , et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997; 336 (4) 243-250
- 69 Mirsaeidi M, Peyrani P, Aliberti S , et al. Thrombocytopenia and thrombocytosis at time of hospitalization predict mortality in patients with community-acquired pneumonia. Chest 2010; 137 (2) 416-420
- 70 Brogly N, Devos P, Boussekey N, Georges H, Chiche A, Leroy O. Impact of thrombocytopenia on outcome of patients admitted to ICU for severe community-acquired pneumonia. J Infect 2007; 55 (2) 136-140
- 71 Chalmers JD, Singanayagam A, Scally C, Hill AT. Admission D-dimer can identify low-risk patients with community-acquired pneumonia. Ann Emerg Med 2009; 53 (5) 633-638
- 72 Snijders D, Schoorl M, Schoorl M, Bartels PC, van der Werf TS, Boersma WG. D-dimer levels in assessing severity and clinical outcome in patients with community-acquired pneumonia. A secondary analysis of a randomised clinical trial. Eur J Intern Med 2012; 23 (5) 436-441
- 73 Querol-Ribelles JM, Tenias JM, Grau E , et al. Plasma d-dimer levels correlate with outcomes in patients with community-acquired pneumonia. Chest 2004; 126 (4) 1087-1092
- 74 Torres A, Sibila O, Ferrer M , et al. Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: a randomized clinical trial. JAMA 2015; 313 (7) 677-686
- 75 Restrepo MI, Anzueto A, Torres A. Corticosteroids for severe community-acquired pneumonia: time to change clinical practice. Ann Intern Med 2015; 163 (7) 560-561
- 76 Christ-Crain M, Stolz D, Jutla S , et al. Free and total cortisol levels as predictors of severity and outcome in community-acquired pneumonia. Am J Respir Crit Care Med 2007; 176 (9) 913-920
- 77 Kolditz M, Halank M, Schulte-Hubbert B, Höffken G. Adrenal function is related to prognosis in moderate community-acquired pneumonia. Eur Respir J 2010; 36 (3) 615-621
- 78 Kolditz M, Höffken G, Martus P , et al; CAPNETZ study group. Serum cortisol predicts death and critical disease independently of CRB-65 score in community-acquired pneumonia: a prospective observational cohort study. BMC Infect Dis 2012; 12: 90
- 79 Salluh JI, Bozza FA, Soares M , et al. Adrenal response in severe community-acquired pneumonia: impact on outcomes and disease severity. Chest 2008; 134 (5) 947-954
- 80 Singanayagam A, Chalmers JD, Hill AT. Admission hypoglycaemia is associated with adverse outcome in community-acquired pneumonia. Eur Respir J 2009; 34 (4) 932-939
- 81 Faverio P, Aliberti S, Bellelli G , et al. The management of community-acquired pneumonia in the elderly. Eur J Intern Med 2014; 25 (4) 312-319
- 82 Restrepo MI, Faverio P, Anzueto A. Long-term prognosis in community-acquired pneumonia. Curr Opin Infect Dis 2013; 26 (2) 151-158