Risikofaktoren für Pneumonien bei Patienten mit kardiovaskulären Grunderkrankungen

Zusammenfassung

In der vorliegenden Fall-Kontroll-Studie wurden kardiovaskuläre Grunderkrankungen als potenzielle Risikofaktoren für ambulant erworbene und nosokomiale Pneumonien auf dem Hintergrund bereits etablierter Risikofaktoren untersucht. Die Studie umfasst 36 konsekutiv stationär behandelte Patienten mit kardiovaskulärer Grunderkrankung und Pneumonie und 36 Kontrollpatienten mit kardiovaskulärer Grunderkrankung, bei denen weder aktuell noch anamnestisch eine Pneumonie bekannt war. Von allen kardiovaskulären Grunderkrankungen erwies sich nur die Herzinsuffizienz als unabhängiger Risikofaktor für Pneumonien (OR 5,69, 95 % KI 1,69 - 19,04, p = 0,0048). Sowohl die chronische (p = 0,009) als auch die akut dekompensierte Herzinsuffizienz (p = 0,028) waren mit einem erhöhten Pneumonie-Risiko assoziiert. Dabei war das Risiko mit dem Ausmaß der Reduktion der linksventrikulären Pumpfunktion in der Echokardiographie assoziiert. Keinen Einfluss auf die Pneumonierate hatten koronare Herzerkrankung, Vitien, Herzrhythmusstörungen, Myokarditis, Endokarditis und Kardiomyopathie, wenn sie nicht mit einer Herzinsuffizienz einhergingen. Pulmonale (OR 9,24, 95 % KI 1,48 - 57,74, p = 0,00174) und renale (OR 7,49, 95 % KI 1,38 - 40,76, p = 0,0197) Erkrankungen konnten als weitere unabhängige Risikofaktoren validiert werden. Auch eine positive Raucheranamnese war mit einem erhöhten Risiko für Pneumonien assoziiert (p = 0,023). Diese Studie unterstützt die Hypothese, dass nicht die kardiovaskuläre Erkrankung an sich, sondern die aus ihr resultierende Herzinsuffizienz den wesentlichen Risikofaktor für Pneumonien darstellt.

Abstract

A case-control-study was performed to identify patients at particularly high risk of community-acquired pneumonia and nosocomial pneumonia with a special focus on cardiovascular diseases as potential risk factors. Thirty-six consecutive hospitalized patients with cardiovascular diseases and pneumonia were matched with 36 controls also suffering from cardiovascular diseases but without pneumonia. From all cardiovascular diseases only heart failure proved to be an independent risk factor for pneumonia (OR 5.69, 95 % KI 1.69 - 19.04, p = 0.0048). Both chronic (p = 0.009) and acute heart failure (p = 0.028) were associated with an increased risk of pneumonia. The risk of pneumonia was closely related to the degree of ventricular function impairment. Coronary heart disease, valvular disease, arrythmia, myocarditis, endocarditis and cardiomyopathy did not increase the risk for pneumonia unless accompanied by heart failure. Pulmonary (OR 9.24, 95 % KI 1.48 - 57.74, p = 0.00174) and renal diseases (OR 7.49, 95 % KI 1.38 - 40.76, p = 0.0197) were validated as additional independent risk factors. A history of smoking was also associated with an increased risk of pneumonia (p = 0,023). This study supports the hypothesis that heart failure resulting from cardiovascular disease and not cardiovascular disease itself mounts the risk for pneumonia.

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