Predictors of cardiovascular events in patients with heart failure and Pseudomonas aeruginosa pneumonia

Aim . To identify predictors of cardiovascular events (CVEs) in patients with heart failure (HF) and P. aeruginosa pneumonia. Material and methods . The study included 92 patients with HF with mildly reduced or reduced ejection fraction and nosocomial pneumonia. Based on sputum or bronchoalveolar lavage microbiological examination, patients were divided into 2 following groups: group I — 51 patients with HF and P. aeruginosa pneumonia, group II — 41 patients with HF and pneumonia caused by other pathogens ( Staphylococcus aureus, Streptococcus pneumoniae ). During the hospital stay, the following morbidities were assessed: cardiovascular death, acute coronary syndrome, non-fatal cerebrovascular accident, pulmonary embolism, lower extremity venous thrombosis. Results . CVEs were significantly more often observed in patients with HF and P. aeruginosa pneumonia — 30 (58,8%) than in patients with HF and pneumonia caused by S. aureus or S. pneumoniae — 5 (12,1%). Complete blood count in group I patients revealed a decrease in hemoglobin level to 114 [95; 133] g/l, when compared with patients in group II — 139 [118; 150] g/l (p<0,001) and an increase in white blood cell count (10,2×10 9 /l and 6,96×10 9 /l, respectively (p<0,001)). A biochemical blood test in group I patients revealed a significant increase in C-reactive protein (CRP) of 105 [60; 191] and 18 [14; 55,1] mg/l (p<0,001). Patients with P. aeruginosa pneumonia had more widespread lung involvement than patients with pneumonia of other etiologies. Conclusion . There are following most significant predictors of cardiovascular events in patients with HF and P. aeruginosa pneumonia: decreased LVEF <40% (relative risk (RR) 1,833; 95% confidence interval (CI) 1,188-3,400; p=0,005), white blood cell count >11×10 9 /l (RR 2,412; 95% CI 1,399-4,158; p=0,048), CRP >133 mg/l (RR 3,115; 95% CI 1,611-6,025; p<0,001) and hypoproteinemia <57 g/l (RR 5,225; 95% CI 1,249-21,854; p=0,012).