Cardiovascular complications after pleural infection: incidences, risk factors, and prognostic relevance

BACKGROUND AND OBJECTIVE: Cardiovascular events (CVEs) are common in patients after pneumonia. The clinical relevance of CVEs in pleural infection is undefined. This study aims to assess their incidence, risk factors and prognostic significance in patients with pleural infection. METHODS: Patients (n = 434) hospitalized for pleural infection over a 12-year period in two Hong Kong hospitals were assessed for CVEs till 1-year follow-up. CVEs included new or worsening heart failure (HF), arrhythmia, myocardial infarction (MI), venous thromboembolism (VTE) and stroke. RESULTS: Incident CVEs occurred in 105 patients (24%). Primary events were HF (48/105, 46%), arrhythmia (38/105, 36%), MI (9/105, 8%), VTE (6/105, 6%), and stroke (4/105, 4%). In the overall cohort, these corresponded to event rates of 11%, 9%, 2%, 1%, and 1%, respectively. Most events (85%) occurred within 28 days of pleural infection presentation. In multivariate analysis, factors associated with CVE occurrence included pre-existing HF (odds ratio [OR] 7.99, 95% CI: 1.52-42.06), prior history of arrhythmia (OR 2.89, 95% CI: 1.19-7.03), history of smoking (OR 1.99, 95% CI 1.20-3.30), higher serum urea (OR 1.11, 95% CI 1.05-1.17) and older age (OR 1.04, 95% CI: 1.02-1.06). Patients classified by RAPID score as high- and medium-risk were 5.89-fold (95% CI 3.35-10.38) and 3.26-fold (95% CI 1.90-5.59) more likely to develop CVEs, compared with those in the low-risk group. Incident CVEs were associated with significantly higher 1-year mortality after adjustment for RAPID score components and microbiological positivity (HR 2.38, 95% CI 1.61-3.51). CONCLUSIONS: Cardiovascular complications are common with pleural infection and are associated with increased mortality. These findings suggest that pleural infection should be regarded not only as a localized pleural condition but also as a condition with important cardiovascular consequences. Targeted strategies to prevent and manage CVE in this population may improve clinical outcomes and warrant further investigation.