| Aims:To analyze the incidence and relative risk factors of cardiovascular events and all-cause mortality, as well as the changes of inflammatory factors, nutrientional and metabolic indices, and their relationshiop with outcomes in the elderly with sCAD after ALRTI. Methods:This is a prospective cohort study. The data of the elderly with sCAD who were hospitalized to the Chinese PLA general hospital from Jan 2013 to Dec 2014 were collected. According to whether or not with ALRTI, these subjects were divided into infection group and no infection group. The patients’ general information, medical history, inflammatory and nutritional indices at baseline were collected, and the incidence of cardiovascular events and all-cause mortality of all subjects were followed up to 90 day after ALRTI. Results:1.1449 consecutive elderly patients with sCAD were chosen as subjects. According to an exclusion criterions and the lost during follow-up, there were 426 patients who were included in this study.2. The incidence rate of CVEs were 7.5%,15.0% and 24.6% in the follow-up period of 7-day,30-day and 90-day (D7, D30 and D90) after adimmsion, and all-cause mortalities were 0.7%, 2.6% and 8.7% in different period of time.3. The incidences of CVEs in infection group were significantly higher than those in no infection group in follow-up period of D7 (10.9% vs 2.4%, p=0.001), D30 (20.6% vs 6.5%, p<0.001) and D90 (31.9% vs 13.6%, p<0.001); The all-cause mortalities were also significantly higher than those in non infection group in follow-up period of D30 (3.9% vs 0.6%, p=0.021) and D90 (13.2% vs 1.7%,p<0.001), except for D7 (1.2% vs 0%, p=0.028).4. The level of RDW in infection group was significantly higher than that in no infection group, and the infection was correlated with RDW level. Meanwhile, the level of RDW in CVEs group was higher than in no CVEs group.5. Compared with those in no infection group, the levels of BMI, Hb, Tlc, BUN, serum sCr, electrolyte (Na+, K+, Ca2+, P3-, Mg2+), Fe3+, FBG, ALB and PA levels were decreased, and the levels of BUN and sCr were increased in infection group. The age and BUN in death group was increased compared with that in survival group, the BMI, Hb, Tlc, Mg2+, ALB, PA and TC in death group was lower than those in survival group.6. In multivariate logistic regression models which fucosed on the mainly clinic parematers, ALRTI (OR 3.907,95%CI 2.316～6.591, P<0.001) chronic kidney disease (OR 2.086,95%CI 1.085～4.013, P= 0.028), breathe rate ≥24bpm(OR 1.093,95% CI 1.006～1.187, P=0.036)and heart rate>125bpm (OR 1.018, 95% CI 1.000～1.037, P=0.045) at baseline were independent risk factors of 90-days composite endpoints in the elderly with sCAD; In multivariate logistic regression models which fucosed on the mainly hematologic indices, ALRTI (OR 4.433,95%CI 2.580～7.713, P<0.001), elevated RDW (OR 1.203,95%CI 1.020-1.420, P=0.028), chronic kidney disease (OR 1.967,95%CI 1.105～3.502, P=0.021) and lower ejection fration (OR 0.961,95%CI 0.929～0.993, P=0.018) were independent risk factors of 90-days composite endpoint in the elderly with sCAD; In multivariate logistic regression models which fucosed on the mainly inflammatory factors, nutrientional and metabolic indices, ALRTI (OR 3.531,95%CI 1.017～12.258, P=0.047), serum BUN (OR 1.113,95%CI 1.026～1.207,P=0.010) and PA (OR 0.920,95%CI 0.860～0.984, P=0.016) were independent risk factors of 90-days all-cause mortaltiy in the elderly with sCAD. Conclusions:The risk of cardiovascular events and all-cause mortality was increased in elderly patients with sCAD during 90 days after ALRTI. And the joint monitoring of the indices of nutritional, inflammatory and RDW might be of great value for the patient’s adverse outcome. Establishing an assessment system of risk stratification and prognosis prediction for elderly patients with sCAD after ALRTI, might hopefully reduce cardiovascular events and all-cause mortality in those patients. |
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