Cardiovascular autonomic alterations in hospitalized patients with community-acquired pneumonia

Stefano Aliberti, Eleonora Tobaldini, Fabio Giuliani, Vanessa Nunziata, Giovanni Casazza, Giulia Suigo, Alice D'Adda, Giulia Bonaiti, Andrea Roveda, Andreia Queiroz, Valter Monzani, Alberto Pesci, Francesco Blasi, Nicola Montano

Research output: Contribution to journalArticle

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Abstract

Background: Alterations of cardiac autonomic control (CAC) are associated with poor outcomes in patients with infectious and non-infectious diseases. No evaluation of CAC in patients with community-acquired pneumonia (CAP) has been performed so far. The aim of the study was to assess CAC in patients with CAP and evaluate the impact of its alterations on disease severity and clinical outcomes in a multicenter, prospective, observational study. Methods: Consecutive patients hospitalized for CAP were enrolled between 2011 and 2013 two university hospitals in Italy. CAC was assessed by linear spectral and non-linear symbolic analysis of heart rate variability. The presence of severe CAP was evaluated on hospital admission. The primary study outcome was time to clinical stability (TCS) during hospitalization. Results: Among the 75 patients enrolled (median age: 75 years; 57 % males), a significantly lower total variability and reduction of sympathetic rhythmical component with predominant respiratory modulation was detected in comparison to controls. Among CAP patients affected by a severe CAP on admission, CAC showed a lower sympathetic modulation and predominant parasympathetic oscillatory rhythm. At the multivariate analysis, variables independently correlated with a TCS >7 days were total power, as marker of total variability, [OR (95 % CI): 0.997 (0.994-1.000), p = 0.0454] and sympathetic modulation [OR (95 % CI): 0.964 (0.932-0.998), p = 0.0367]. Conclusions: Loss of sympathetic rhythmical oscillation is associated with a more severe disease and worse early clinical outcome in hospitalized patients with CAP.

Original languageEnglish
Article number98
JournalRespiratory Research
Volume17
Issue number1
DOIs
Publication statusPublished - Aug 4 2016

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Pneumonia
Italy
Observational Studies
Hospitalization
Multivariate Analysis
Heart Rate
Outcome Assessment (Health Care)
Prospective Studies

Keywords

  • Cardiac autonomic control
  • Heart rate variability
  • Pneumonia
  • Spectral analysis
  • Symbolic analysis
  • Sympathetic

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Cardiovascular autonomic alterations in hospitalized patients with community-acquired pneumonia. / Aliberti, Stefano; Tobaldini, Eleonora; Giuliani, Fabio; Nunziata, Vanessa; Casazza, Giovanni; Suigo, Giulia; D'Adda, Alice; Bonaiti, Giulia; Roveda, Andrea; Queiroz, Andreia; Monzani, Valter; Pesci, Alberto; Blasi, Francesco; Montano, Nicola.

In: Respiratory Research, Vol. 17, No. 1, 98, 04.08.2016.

Research output: Contribution to journalArticle

Aliberti, Stefano ; Tobaldini, Eleonora ; Giuliani, Fabio ; Nunziata, Vanessa ; Casazza, Giovanni ; Suigo, Giulia ; D'Adda, Alice ; Bonaiti, Giulia ; Roveda, Andrea ; Queiroz, Andreia ; Monzani, Valter ; Pesci, Alberto ; Blasi, Francesco ; Montano, Nicola. / Cardiovascular autonomic alterations in hospitalized patients with community-acquired pneumonia. In: Respiratory Research. 2016 ; Vol. 17, No. 1.
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abstract = "Background: Alterations of cardiac autonomic control (CAC) are associated with poor outcomes in patients with infectious and non-infectious diseases. No evaluation of CAC in patients with community-acquired pneumonia (CAP) has been performed so far. The aim of the study was to assess CAC in patients with CAP and evaluate the impact of its alterations on disease severity and clinical outcomes in a multicenter, prospective, observational study. Methods: Consecutive patients hospitalized for CAP were enrolled between 2011 and 2013 two university hospitals in Italy. CAC was assessed by linear spectral and non-linear symbolic analysis of heart rate variability. The presence of severe CAP was evaluated on hospital admission. The primary study outcome was time to clinical stability (TCS) during hospitalization. Results: Among the 75 patients enrolled (median age: 75 years; 57 {\%} males), a significantly lower total variability and reduction of sympathetic rhythmical component with predominant respiratory modulation was detected in comparison to controls. Among CAP patients affected by a severe CAP on admission, CAC showed a lower sympathetic modulation and predominant parasympathetic oscillatory rhythm. At the multivariate analysis, variables independently correlated with a TCS >7 days were total power, as marker of total variability, [OR (95 {\%} CI): 0.997 (0.994-1.000), p = 0.0454] and sympathetic modulation [OR (95 {\%} CI): 0.964 (0.932-0.998), p = 0.0367]. Conclusions: Loss of sympathetic rhythmical oscillation is associated with a more severe disease and worse early clinical outcome in hospitalized patients with CAP.",
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AU - Aliberti, Stefano

AU - Tobaldini, Eleonora

AU - Giuliani, Fabio

AU - Nunziata, Vanessa

AU - Casazza, Giovanni

AU - Suigo, Giulia

AU - D'Adda, Alice

AU - Bonaiti, Giulia

AU - Roveda, Andrea

AU - Queiroz, Andreia

AU - Monzani, Valter

AU - Pesci, Alberto

AU - Blasi, Francesco

AU - Montano, Nicola

PY - 2016/8/4

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N2 - Background: Alterations of cardiac autonomic control (CAC) are associated with poor outcomes in patients with infectious and non-infectious diseases. No evaluation of CAC in patients with community-acquired pneumonia (CAP) has been performed so far. The aim of the study was to assess CAC in patients with CAP and evaluate the impact of its alterations on disease severity and clinical outcomes in a multicenter, prospective, observational study. Methods: Consecutive patients hospitalized for CAP were enrolled between 2011 and 2013 two university hospitals in Italy. CAC was assessed by linear spectral and non-linear symbolic analysis of heart rate variability. The presence of severe CAP was evaluated on hospital admission. The primary study outcome was time to clinical stability (TCS) during hospitalization. Results: Among the 75 patients enrolled (median age: 75 years; 57 % males), a significantly lower total variability and reduction of sympathetic rhythmical component with predominant respiratory modulation was detected in comparison to controls. Among CAP patients affected by a severe CAP on admission, CAC showed a lower sympathetic modulation and predominant parasympathetic oscillatory rhythm. At the multivariate analysis, variables independently correlated with a TCS >7 days were total power, as marker of total variability, [OR (95 % CI): 0.997 (0.994-1.000), p = 0.0454] and sympathetic modulation [OR (95 % CI): 0.964 (0.932-0.998), p = 0.0367]. Conclusions: Loss of sympathetic rhythmical oscillation is associated with a more severe disease and worse early clinical outcome in hospitalized patients with CAP.

AB - Background: Alterations of cardiac autonomic control (CAC) are associated with poor outcomes in patients with infectious and non-infectious diseases. No evaluation of CAC in patients with community-acquired pneumonia (CAP) has been performed so far. The aim of the study was to assess CAC in patients with CAP and evaluate the impact of its alterations on disease severity and clinical outcomes in a multicenter, prospective, observational study. Methods: Consecutive patients hospitalized for CAP were enrolled between 2011 and 2013 two university hospitals in Italy. CAC was assessed by linear spectral and non-linear symbolic analysis of heart rate variability. The presence of severe CAP was evaluated on hospital admission. The primary study outcome was time to clinical stability (TCS) during hospitalization. Results: Among the 75 patients enrolled (median age: 75 years; 57 % males), a significantly lower total variability and reduction of sympathetic rhythmical component with predominant respiratory modulation was detected in comparison to controls. Among CAP patients affected by a severe CAP on admission, CAC showed a lower sympathetic modulation and predominant parasympathetic oscillatory rhythm. At the multivariate analysis, variables independently correlated with a TCS >7 days were total power, as marker of total variability, [OR (95 % CI): 0.997 (0.994-1.000), p = 0.0454] and sympathetic modulation [OR (95 % CI): 0.964 (0.932-0.998), p = 0.0367]. Conclusions: Loss of sympathetic rhythmical oscillation is associated with a more severe disease and worse early clinical outcome in hospitalized patients with CAP.

KW - Cardiac autonomic control

KW - Heart rate variability

KW - Pneumonia

KW - Spectral analysis

KW - Symbolic analysis

KW - Sympathetic

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