1 Introduction
Despite improved management by antibiotic therapy the risk of hospitalization, morbidity and mortality is still elevated in community-acquired pneumonia (CAP) patients.1Cardiovascular disease represents a harmful complication occurring in the early phase of hospitalization.2,3 In a large prospective study including 1,182 CAP patients, cardiovascular events such as myocardial infarction (MI), heart failure and stroke occurred in 32% of patients during the first 48 hours from admission and increased the risk of mortality and cardiovascular recurrences in short- and long-term follow-up.4
In accordance with this finding, we have previously reported that CAP patients display an early increase of cardiac troponin, in >50% of patients, which was accompanied to ECG modification compatible with NSTEMI in the majority of cases.5
The impact of corticosteroid use in CAP patients provided conflicting results with meta-analyses showing a positive effects in terms of reduction of death,6,7 an effect, however, not confirmed by others. 8,9 Accordingly, guidelines form American Thoracic Society and the Infectious Diseases Society of America advise against the use of corticosteroids in CAP unless of precise indications for their use as in case of coexistent asthma, chronic obstructive pulmonary disease (COPD) or autoimmune diseases.10
Corticosteroids seem to have also an effect on cardiac complications of CAP patients as shown by a retrospective study conducted in 493 CAP patients, in which we found that corticosteroid users presented a significant reduction of MI compared to the non-users.11 However, this beneficial effect was limited to patients with concomitant COPD.
Due to the negative association between myocardial injury and long-term adverse outcomes, we speculated that corticosteroids may prevent troponin release and eventually reduce major adverse cardiovascular events (MACE).