Impaired flow-mediated dilation in hospitalized patients with community-acquired pneumonia.

Abstract

BACKGROUND:

Community-acquired pneumonia (CAP) is complicated by cardiovascular events as myocardial infarction and stroke but the underlying mechanism is still unclear. We hypothesized that endothelial dysfunction may be implicated and that endotoxemia may have a role.

METHODS:

Fifty patients with CAP and 50 controls were enrolled. At admission and at discharge, flow-mediated dilation (FMD), serum levels of endotoxins and oxidative stress, as assessed by serum levels of nitrite/nitrate (NOx) and isoprostanes, were studied.

RESULTS:

At admission, a significant difference between patients with CAP and controls was observed for FMD (2.1±0.3 vs 4.0±0.3%, p<0.001), serum endotoxins (157.8±7.6 vs 33.1±4.8pg/ml), serum isoprostanes (341±14 vs 286±10 pM, p=0.009) and NOx (24.3±1.1 vs 29.7±2.2μM). Simple linear correlation analysis showed that serum endotoxins significantly correlated with Pneumonia Severity Index score (Rs=0.386, p=0.006). Compared to baseline, at discharge CAP patients showed a significant increase of FMD and NOx (from 2.1±0.3 to 4.6±0.4%, p<0.001 and from 24.3±1.1 to 31.1±1.5μM, p<0.001, respectively) and a significant decrease of serum endotoxins and isoprostanes (from 157.8±7.6 to 55.5±2.3pg/ml, p<0.001, and from 341±14 to 312±14 pM, p<0.001, respectively). Conversely, no changes for FMD, NOx, serum endotoxins and isoprostanes were observed in controls between baseline and discharge. Changes of FMD significantly correlated with changes of serum endotoxins (Rs=-0.315; p=0.001).

CONCLUSIONS:

The study provides the first evidence that CAP is characterized by impaired FMD with a mechanism potentially involving endotoxin production and oxidative stress.

• Authors: Lorenzo Loffredo, Roberto Cangemi, Ludovica Perri, Elisa Catasca, Camilla Calvieri, Roberto Carnevale, Cristina Nocella, Francesco Equitani, Domenico Ferro, Francesco Violi, SIXTUS study group, SIXTUS (thromboSIs-related eXTra-pulmonary oUtcomeS in pneumonia) study group, Simona Battaglia, Giuliano Bertazzoni, Elisa Biliotti, Tommaso Bucci, Cinzia Myriam Calabrese, Marco Casciaro, Andrea Celestini, Maurizio De Angelis, Paolo De Marzio, Rozenn Esvan, Marco Falcone, Lucia Fazi, Lucia Fontanelli Sulekova, Cristiana Franchi, Laura Giordo, Stefania Grieco, Elisa Manzini, Paolo Marinelli, Michela Mordenti, Sergio Morelli, Paolo Palange, Daniele Pastori, Pasquale Pignatelli, Marco Rivano Capparuccia, Giulio Francesco Romiti, Elisabetta Rossi, Eleonora Ruscio, Alessandro Russo, Maria Gabriella Scarpellini, Luisa Solimando, Gloria Taliani, Stefano Trapè, Filippo Toriello
• Journal: European journal of internal medicine (Eur J Intern Med) Vol. 36 Pg. 74-80 (Dec 2016) ISSN: 1879-0828 [Electronic] Netherlands
• PMID: 27727076 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Chemical References

• Isoprostanes
• Lipopolysaccharides
• Nitrates
• Nitrites

Topics

• Aged
• Aged, 80 and over
• Brachial Artery (diagnostic imaging, physiopathology)
• Community-Acquired Infections (blood, physiopathology)
• Endothelium, Vascular (physiopathology)
• Female
• Hospitalization
• Humans
• Isoprostanes (blood)
• Lipopolysaccharides (blood)
• Male
• Middle Aged
• Nitrates (blood)
• Nitrites (blood)
• Oxidative Stress
• Pneumonia (blood, physiopathology)
• Prospective Studies
• Ultrasonography
• Vasodilation