Corticosteroid use, myocardial injury and in-hospital cardiovascular
events in patients with community-acquired pneumonia
Abstract
Background and Purpose: Patients with community acquired pneumonia (CAP)
may suffer from myocardial injury, which is associated with increased
risk of major adverse cardiovascular events (MACE). Corticosteroids are
often prescribed to CAP patients, but the relationship between their
use, myocardial injury and outcomes in these patients is unknown.
Experimental Approach: 541 CAP patients were recruited (334 males; mean
age: 71.9±16.2 years). High-sensitivity troponin T (hs-cTnT) was
measured at admission, during the hospital stay and at discharge. MACE
occurrence was registered during a long-term follow-up. Key Results:
Overall, 318 patients (59%) showed hs-cTnT elevation >
99th percentile (>0.014 µg/L). Patients with hs-cTnT
elevation were older, more likely to be former smokers, and with a
higher prevalence of cardiovascular comorbidities. In a median follow-up
of 22.7 months, a multivariable Cox proportional hazard regression
analysis showed age, heart failure and the increasing quintiles of
hs-cTnT (HR: 2.16; 95% CI: 1.82-2.58; p<0.001) predicted
MACE. In-hospital corticosteroid use was found in 137 (25%) patients.
Among patients with hs-cTnT >0.014 µg/L at admission, 102
patients (31%) were on corticosteroids and showed lower intra-hospital
hs-cTnT increase compared to untreated ones (p=0.003). Among patients
with hs-cTnT >0.014 µg/L, corticosteroid-treated patients
showed a lower incidence of MACE than untreated ones [29% (27/99) vs.
43% (92/213); p value =0.042]; no effect of corticosteroids on MACE
was observed in CAP patients with normal troponin. Conclusion and
Implications: The study provides evidence that corticosteroid use is
associated with lower increase of hs-cTnT and incidence of MACE in CAP
patients.