<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0001-6002</journal-id>
<journal-title><![CDATA[Acta Médica Costarricense]]></journal-title>
<abbrev-journal-title><![CDATA[Acta méd. costarric]]></abbrev-journal-title>
<issn>0001-6002</issn>
<publisher>
<publisher-name><![CDATA[Colegio de Médicos y Cirujanos de Costa Rica]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0001-60022017000300095</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Complicaciones cardiovasculares en pacientes hospitalizados con neumonía adquirida en la comunidad: estudio de cohorte retrospectivo]]></article-title>
<article-title xml:lang="en"><![CDATA[Cardiovascular complications in hospitalized patients with community-acquired pneumonia: retrospective cohort study]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Álvarez-Aguilar]]></surname>
<given-names><![CDATA[Pablo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Peña-Varela]]></surname>
<given-names><![CDATA[Julián]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[García-Sánchez]]></surname>
<given-names><![CDATA[Mariana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital México Sección de Medicina ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad de Costa Rica Escuela de Medicina Departamento de Fisiología]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Costa Rica</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>09</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>09</month>
<year>2017</year>
</pub-date>
<volume>59</volume>
<numero>3</numero>
<fpage>95</fpage>
<lpage>102</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_arttext&amp;pid=S0001-60022017000300095&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_abstract&amp;pid=S0001-60022017000300095&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_pdf&amp;pid=S0001-60022017000300095&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Justificación y objetivo: Algunos estudios han documentado mayor riesgo de eventos cardiovasculares en pacientes con neumonía adquirida en la comunidad. El objetivo del estudio es caracterizar la población de pacientes con diagnóstico de neumonía adquirida en la comunidad e identificar factores relacionados con el desarrollo de complicaciones cardiovasculares y muerte a 30 días.  Métodos: Se realizó un estudio observacional de cohorte retrospectivo con casos y controles en el Servicio de Medicina Interna en un hospital universitario de nivel terciario, con pacientes con diagnóstico de neumonía adquirida en la comunidad. Se evaluaron variables clínicas y de laboratorio de los pacientes ingresados, así como diagnóstico clínico de arritmia, infarto agudo de miocardio, insuficiencia cardiaca de nuevo, o empeoramiento de cuadro preexistente, edema pulmonar y muerte en los 30 días posteriores al ingreso (casos), o ausencia de estos hallazgos (controles).  Resultados: Se identificó 35 casos de neumonía adquirida en la comunidad, de los cuales 17 presentaron complicaciones cardiovasculares (48,57%). Los pacientes de mayor edad, de sexo femenino, hipertensos y cardiópatas isquémicos, tuvieron mayor riesgo de eventos cardiovasculares, así como los que presentaron al ingreso mayores valores de presión sistólica, creatin fosfokinasa y nitrógeno ureico. El 22,85% de los pacientes falleció en los siguientes 30 días posteriores al ingreso por neumonía; el riesgo de muerte fue mayor para los pacientes con complicaciones cardiovasculares [Hazard ratio 8,8 (IC95% 1,08-71,66; p=0,03)]. No se encontró asociación entre las diferencias clínicas identificadas y el desenlace fatal. Limitaciones: las variables se tomaron de los expedientes clínicos, dependiendo completamente del criterio de los médicos tratantes para solicitud de exámenes y asignación de variables. Es posible la presencia de factores de confusión debido a covariables no medidas o severidad de la enfermedad.  Conclusión: En los pacientes internados con diagnóstico de neumonía adquirida en la comunidad, el desarrollo de complicaciones cardiovasculares se asoció con aumento de mortalidad.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Justification and objectives: Previous studies have demonstrated increased risk of cardiovascular events in patients with community-acquired pneumonia. The objective of this study is to characterize the population of patients diagnosed with community-acquired pneumonia and identify factors associated with the development of cardiovascular complications and 30-day mortality.  Methods: A retrospective observational case-control cohort was done, with cases and controls in the department of Internal Medicine at a tertiary level teaching hospital with patients diagnosed with community-acquired pneumonia. Clinical and laboratory variables of patients admitted were evaluated, also the clinical diagnosis of arrhythmia, acute myocardial infarction, heart failure (new or worsening), pulmonary edema and death within 30 days after admission (cases) or absence of these findings (controls).  Results: 35 cases of community-acquired pneumonia were identified on the first semester of 2015, of which 17 (48.57%) developed cardiovascular complications. Older patients, female sex, hypertension and ischemic heart disease demonstrated higher risk of cardiovascular events, as well as presenting the systolic blood pressure, creatine phosphokinase and urea nitrogen. The 22.85% of patients died within 30 days after being admitted; the risk of death was higher for patients with cardiovascular complications [Hazard ratio 8.8 (95% CI 1.08-71.66; p = 0.03)]. No association between the identified clinical differences and fatal outcome was found. Limitations: The retrospective nature of the study and the variables, which were collected from clinical records, depended entirely on the discretion of the treating physicians to request tests and variable allocation. The presence of confounding is possible due to unmeasured covariates or disease severity.  Conclusions: In patients admitted with a diagnosis of community-acquired pneumonia the development of cardiovascular complications was associated with increased mortality.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[neumonía adquirida en la comunidad]]></kwd>
<kwd lng="es"><![CDATA[mortalidad]]></kwd>
<kwd lng="es"><![CDATA[infarto del miocardio]]></kwd>
<kwd lng="es"><![CDATA[arritmia]]></kwd>
<kwd lng="es"><![CDATA[falla cardiaca]]></kwd>
<kwd lng="es"><![CDATA[edema agudo de pulmón]]></kwd>
<kwd lng="en"><![CDATA[Community-acquired pneumonia]]></kwd>
<kwd lng="en"><![CDATA[mortality]]></kwd>
<kwd lng="en"><![CDATA[acute myocardial infarction]]></kwd>
<kwd lng="en"><![CDATA[arrhythmia]]></kwd>
<kwd lng="en"><![CDATA[heart failure]]></kwd>
<kwd lng="en"><![CDATA[acute pulmonary edema]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Corrales-Medina]]></surname>
<given-names><![CDATA[VF]]></given-names>
</name>
<name>
<surname><![CDATA[Musher]]></surname>
<given-names><![CDATA[DM]]></given-names>
</name>
<name>
<surname><![CDATA[Shachkina]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Chirinos]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Acute pneumonia and the cardiovascular system]]></article-title>
<source><![CDATA[Lancet]]></source>
<year>2013</year>
<volume>381</volume>
<page-range>496-505</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Saldías]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Viviani]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Pulgar]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Valenzuela]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Paredes, P OD]]></surname>
<given-names><![CDATA[Sebastián]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Factores pronósticos, evolución y por neumonía neumocócica adquirida en la comunidad]]></article-title>
<source><![CDATA[Med Chil]]></source>
<year>2009</year>
<page-range>1545-52</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Corrales-Medina]]></surname>
<given-names><![CDATA[VF]]></given-names>
</name>
<name>
<surname><![CDATA[Musher]]></surname>
<given-names><![CDATA[DM]]></given-names>
</name>
<name>
<surname><![CDATA[Wells]]></surname>
<given-names><![CDATA[GA]]></given-names>
</name>
<name>
<surname><![CDATA[Chirinos]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Chen]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Fine]]></surname>
<given-names><![CDATA[MJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Cardiac complications in patients with community-acquired pneumonia incidence, timing, risk factors, and association with short-term mortality]]></article-title>
<source><![CDATA[Circulation]]></source>
<year>2012</year>
<volume>125</volume>
<page-range>773-81</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Baylin]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Hernandez-Diaz]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Siles]]></surname>
<given-names><![CDATA[X]]></given-names>
</name>
<name>
<surname><![CDATA[Kabagambe]]></surname>
<given-names><![CDATA[EK]]></given-names>
</name>
<name>
<surname><![CDATA[Campos]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Triggers of Nonfatal Myocardial Infarction in Costa Rica: Heavy Physical Exertion, Sexual Activity, and Infection]]></article-title>
<source><![CDATA[Ann Epidemiol]]></source>
<year>2007</year>
<volume>17</volume>
<page-range>112-8</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Singanayagama]]></surname>
<given-names><![CDATA[Elder DHJ]]></given-names>
</name>
<name>
<surname><![CDATA[Chalmers]]></surname>
<given-names><![CDATA[JD]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Is community-acquired pneumonia an independent risk factor for cardiovascular disease?]]></article-title>
<source><![CDATA[Eur Respir J]]></source>
<year>2012</year>
<volume>39</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>187-96</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dong]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Liu]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Li]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Association between acute infections and risk of acute coronary syndrome: A meta-analysis]]></article-title>
<source><![CDATA[Int J Cardiol]]></source>
<year>2011</year>
<volume>147</volume>
<page-range>479-82</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Chang]]></surname>
<given-names><![CDATA[CL]]></given-names>
</name>
<name>
<surname><![CDATA[Mills]]></surname>
<given-names><![CDATA[GD]]></given-names>
</name>
<name>
<surname><![CDATA[Karalus]]></surname>
<given-names><![CDATA[NC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Biomarkers of Cardiac Dysfunction and Mortality from Community-Acquired Pneumonia in Adults]]></article-title>
<source><![CDATA[PLoS One]]></source>
<year>2013</year>
<volume>8</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>1-7</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Musher]]></surname>
<given-names><![CDATA[DM]]></given-names>
</name>
<name>
<surname><![CDATA[Rueda]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Kaka]]></surname>
<given-names><![CDATA[AS]]></given-names>
</name>
<name>
<surname><![CDATA[Mapara]]></surname>
<given-names><![CDATA[SM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The Association between Pneumococcal Pneumonia and Acute Cardiac Events]]></article-title>
<source><![CDATA[Clin Infect Dis]]></source>
<year>2007</year>
<volume>45</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>158-65</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Khand]]></surname>
<given-names><![CDATA[AU]]></given-names>
</name>
<name>
<surname><![CDATA[Gemmell]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Rankin]]></surname>
<given-names><![CDATA[AC]]></given-names>
</name>
<name>
<surname><![CDATA[Cleland]]></surname>
<given-names><![CDATA[JGF]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Clinical events leading to the progression of heart failure: Insights from a national database of hospital discharges]]></article-title>
<source><![CDATA[Eur Heart J]]></source>
<year>2001</year>
<volume>22</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>153-64</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Griffin]]></surname>
<given-names><![CDATA[AT]]></given-names>
</name>
<name>
<surname><![CDATA[Wiemken]]></surname>
<given-names><![CDATA[TL]]></given-names>
</name>
<name>
<surname><![CDATA[Arnold]]></surname>
<given-names><![CDATA[FW]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Risk factors for cardiovascular events in hospitalized patients with community-acquired pneumonia]]></article-title>
<source><![CDATA[Int J Infect Dis]]></source>
<year>2013</year>
<volume>17</volume>
<numero>12</numero>
<issue>12</issue>
<page-range>e1125-9</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
