Coronary and Cerebrovascular Events and Exacerbation of Existing Conditions After Laboratory-Confirmed Influenza Infection Among US Veterans: A Self-Controlled Case Series Study

IF 4.3 4区医学 Q1 INFECTIOUS DISEASES Influenza and Other Respiratory Viruses Pub Date : 2024-06-06 DOI:10.1111/irv.13304

Caroline Korves, Nabin Neupane, Jeremy Smith, Yinong Young-Xu, Robertus van Aalst, Salaheddin M. Mahmud, Matthew M. Loiacono

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Abstract

Background

Influenza may contribute to coronary/cerebrovascular events and exacerbate underlying conditions.

Methods

We used self-controlled case series (SCCS) design to analyze data from US Veterans ≥18 years with coronary/cerebrovascular or exacerbation event +/−1 year of lab-confirmed influenza (LCI) during 2010–2018. We estimated the incidence ratio (IR) (95% CI) of the event for risk interval (Days 1–7 post-LCI) versus control interval (all other times +/−1 year of LCI) with fixed-effects conditional Poisson regression. We included biomarker data for mediation analysis.

Results

We identified 3439 episodes with coronary/cerebrovascular-related hospitalizations. IRs (95% CI) for LCI risk versus control interval were STEMI 0.6 (0.1, 4.4), NSTEMI 7.3 (5.8, 9.2), ischemic stroke 4.0 (3.0, 5.4), hemorrhagic stroke 6.2 (3.4, 11.5), and coronary spasm 1.3 (0.5, 3.0). IR significantly increased for NSTEMI and ischemic stroke among those ≥ 65 years. IR for NSTEMI and ischemic stroke dropped 26% and 10%, respectively, when white blood cell (WBC) and platelet count were considered. LCI was significantly associated with exacerbation of preexisting asthma, chronic obstructive pulmonary disease, and congestive heart failure.

Conclusions

We found significant association between LCI and hospitalization for NSTEMI, ischemic stroke, and hemorrhagic stroke, the latter possibly due to unaccounted time-varying confounding in SCCS design.

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美国退伍军人在实验室确诊感染流感后发生冠状动脉和脑血管事件以及现有病症加重：一项自我控制病例系列研究

背景：流感可能会导致冠状动脉/脑血管事件，并加重基础疾病：我们采用自控病例系列（SCCS）设计分析了2010-2018年期间≥18岁的美国退伍军人的数据，这些退伍军人在实验室确诊流感（LCI）后+/-1年内发生了冠心病/脑血管事件或病情恶化。我们使用固定效应条件泊松回归估算了风险区间（LCI 后第 1-7 天）与对照区间（LCI +/-1 年的所有其他时间）的事件发生率比 (IR) (95% CI)。我们纳入了生物标志物数据进行中介分析：我们确定了 3439 例冠心病/脑血管相关住院病例。LCI风险与对照区间的IR（95% CI）分别为：STEMI 0.6（0.1，4.4），NSTEMI 7.3（5.8，9.2），缺血性卒中 4.0（3.0，5.4），出血性卒中 6.2（3.4，11.5），冠状动脉痉挛 1.3（0.5，3.0）。在≥65 岁的人群中，NSTEMI 和缺血性卒中的 IR 明显增加。如果考虑白细胞（WBC）和血小板计数，NSTEMI 和缺血性中风的 IR 分别下降 26% 和 10%。LCI与原有哮喘、慢性阻塞性肺病和充血性心力衰竭的加重有明显相关性：结论：我们发现LCI与NSTEMI、缺血性中风和出血性中风的住院治疗有明显关系，后者可能是由于SCCS设计中未考虑时变混杂因素所致。

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来源期刊

Influenza and Other Respiratory Viruses 医学-病毒学

CiteScore

7.20

自引率

4.50%

发文量

120

审稿时长

6-12 weeks

期刊介绍： Influenza and Other Respiratory Viruses is the official journal of the International Society of Influenza and Other Respiratory Virus Diseases - an independent scientific professional society - dedicated to promoting the prevention, detection, treatment, and control of influenza and other respiratory virus diseases. Influenza and Other Respiratory Viruses is an Open Access journal. Copyright on any research article published by Influenza and Other Respiratory Viruses is retained by the author(s). Authors grant Wiley a license to publish the article and identify itself as the original publisher. Authors also grant any third party the right to use the article freely as long as its integrity is maintained and its original authors, citation details and publisher are identified.