Recurrent pericarditis in older adults: Clinical and laboratory features and outcome

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY Journal of the American Geriatrics Society Pub Date : 2024-09-09 DOI:10.1111/jgs.19150

Emanuele Bizzi MD, Francesco Cavaleri MD, Ruggiero Mascolo MD, Edoardo Conte MD, Stefano Maggiolini MD, Caterina Chiara Decarlini MD, Silvia Maestroni MD, Valentino Collini MD, Ludovico Luca Sicignano MD, Elena Verrecchia MD, Raffaele Manna MD, Massimo Pancrazi MD, Lucia Trotta MD, Giuseppe Lopalco MD, Danilo Malandrino MD, Giada Pallini MD, Sara Catenazzi MD, Luisa Carrozzo MD, Giacomo Emmi MD, George Lazaros MD, Antonio Brucato MD, Massimo Imazio MD

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Abstract

Background

Current guidelines for the diagnosis and treatment of pericarditis refer to the general adult population. Few and fragmentary data regarding recurrent pericarditis in older adults exist.

Objective of the Study

Given the absence of specific data in scientific literature, we hypothesized that there might be clinical, laboratory and outcome differences between young adults and older adults affected by idiopathic recurrent pericarditis.

Materials and Methods

We performed an international multicentric retrospective cohort study analyzing data from patients affected by recurrent pericarditis (idiopathic or post-cardiac injury) and referring to tertiary referral centers. Clinical, laboratory, and outcome data were compared between patients younger than 65 years (controls) and patients aged 65 or older.

Results

One hundred and thirty-three older adults and 142 young adult controls were enrolled. Comorbidities, including chronic kidney diseases, atrial fibrillation, and diabetes, were more present in older adults. The presenting symptom was dyspnea in 54.1% of the older adults versus 10.6% in controls (p < 0.001); pain in 32.3% of the older adults versus 80.3% of the controls (p < 0.001). Fever higher than 38°C was present in 33.8% versus 53.5% (p = 0.001). Pleural effusion was more prevalent in the older adults (55.6% vs 34.5%, p < 0.001), as well as severe pericardial effusion (>20 mm) (24.1% vs 12.7%, p = 0.016) and pericardiocentesis (16.5% vs 8.5%, p = 0.042). Blood leukocyte counts were significantly lower in the older adults (mean + SE: 10,227 + 289/mm³ vs 11,208 + 285/mm³, p = 0.016). Concerning therapies, NSAIDS were used in 63.9% of the older adults versus 80.3% in the younger (p = 0.003), colchicine in 76.7% versus 87.3% (p = 0.023), corticosteroids in 49.6% versus 26.8% (p < 0.001), and anakinra in 14.3% versus 23.9% (p = 0.044).

Conclusions

Older adults affected by recurrent pericarditis show a different clinical pattern, with more frequent dyspnea, pleural effusion, severe pericardial effusion, and lower fever and lower leukocyte count, making the diagnosis sometimes challenging. They received significantly less NSAIDs and colchicine, likely due to comorbidities; they were also treated less commonly with anti-IL1 agents, and more frequently with corticosteroids.

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老年人复发性心包炎：临床和实验室特征及预后

背景：目前的心包炎诊断和治疗指南针对的是普通成年人。有关老年人复发性心包炎的数据极少且零散：鉴于科学文献中缺乏具体数据，我们假设特发性复发性心包炎患者中的年轻人和老年人在临床、实验室和治疗效果方面可能存在差异：我们进行了一项国际多中心回顾性队列研究，分析了受复发性心包炎（特发性或心脏损伤后）影响并转诊至三级转诊中心的患者的数据。对 65 岁以下患者（对照组）和 65 岁或以上患者的临床、实验室和结果数据进行了比较：结果：133 名老年人和 142 名年轻成人对照组参加了研究。老年人合并症较多，包括慢性肾病、心房颤动和糖尿病。出现呼吸困难症状的老年人占 54.1%，而对照组为 10.6%（P 20 毫米）（24.1% 对 12.7%，P = 0.016），出现心包穿刺症状的老年人占 16.5%，而对照组为 8.5%，P = 0.042）。老年人的血白细胞计数明显较低（平均值 + SE：10227 + 289/mm3 vs 11208 + 285/mm3，p = 0.016）。在治疗方法方面，63.9%的老年人使用非甾体抗炎药，而年轻人则为80.3%（P = 0.003）；76.7%的老年人使用秋水仙碱，而年轻人则为87.3%（P = 0.023）；49.6%的老年人使用皮质类固醇，而年轻人则为26.8%（P 结论：非甾体抗炎药和秋水仙碱在老年人中的使用率均高于年轻人：受复发性心包炎影响的老年人表现出不同的临床模式，更频繁地出现呼吸困难、胸腔积液、严重心包积液，发热更低，白细胞计数更低，因此诊断有时具有挑战性。他们接受非甾体抗炎药和秋水仙碱治疗的次数明显较少，这可能是由于合并症所致；他们接受抗IL1药物治疗的次数也较少，而接受皮质类固醇治疗的次数较多。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.

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