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
{"title":"老年人复发性心包炎：临床和实验室特征及预后","authors":"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","doi":"10.1111/jgs.19150","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Objective of the Study</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Materials and Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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 (<i>p</i> < 0.001); pain in 32.3% of the older adults versus 80.3% of the controls (<i>p</i> < 0.001). Fever higher than 38°C was present in 33.8% versus 53.5% (<i>p</i> = 0.001). Pleural effusion was more prevalent in the older adults (55.6% vs 34.5%, <i>p</i> < 0.001), as well as severe pericardial effusion (>20 mm) (24.1% vs 12.7%, <i>p</i> = 0.016) and pericardiocentesis (16.5% vs 8.5%, <i>p</i> = 0.042). Blood leukocyte counts were significantly lower in the older adults (mean + SE: 10,227 + 289/mm<sup>3</sup> vs 11,208 + 285/mm<sup>3</sup>, <i>p</i> = 0.016). Concerning therapies, NSAIDS were used in 63.9% of the older adults versus 80.3% in the younger (<i>p</i> = 0.003), colchicine in 76.7% versus 87.3% (<i>p</i> = 0.023), corticosteroids in 49.6% versus 26.8% (<i>p</i> < 0.001), and anakinra in 14.3% versus 23.9% (<i>p</i> = 0.044).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3467-3475"},"PeriodicalIF":4.3000,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19150","citationCount":"0","resultStr":"{\"title\":\"Recurrent pericarditis in older adults: Clinical and laboratory features and outcome\",\"authors\":\"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\",\"doi\":\"10.1111/jgs.19150\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Objective of the Study</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Materials and Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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 (<i>p</i> < 0.001); pain in 32.3% of the older adults versus 80.3% of the controls (<i>p</i> < 0.001). Fever higher than 38°C was present in 33.8% versus 53.5% (<i>p</i> = 0.001). Pleural effusion was more prevalent in the older adults (55.6% vs 34.5%, <i>p</i> < 0.001), as well as severe pericardial effusion (>20 mm) (24.1% vs 12.7%, <i>p</i> = 0.016) and pericardiocentesis (16.5% vs 8.5%, <i>p</i> = 0.042). Blood leukocyte counts were significantly lower in the older adults (mean + SE: 10,227 + 289/mm<sup>3</sup> vs 11,208 + 285/mm<sup>3</sup>, <i>p</i> = 0.016). Concerning therapies, NSAIDS were used in 63.9% of the older adults versus 80.3% in the younger (<i>p</i> = 0.003), colchicine in 76.7% versus 87.3% (<i>p</i> = 0.023), corticosteroids in 49.6% versus 26.8% (<i>p</i> < 0.001), and anakinra in 14.3% versus 23.9% (<i>p</i> = 0.044).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>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.</p>\\n </section>\\n </div>\",\"PeriodicalId\":17240,\"journal\":{\"name\":\"Journal of the American Geriatrics Society\",\"volume\":\"72 11\",\"pages\":\"3467-3475\"},\"PeriodicalIF\":4.3000,\"publicationDate\":\"2024-09-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19150\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Geriatrics Society\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/jgs.19150\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GERIATRICS & GERONTOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Geriatrics Society","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jgs.19150","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
Recurrent pericarditis in older adults: Clinical and laboratory features and outcome
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.
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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