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Corticosteroid use, myocardial injury and in-hospital cardiovascular events in patients with community-acquired pneumonia
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  • Roberto Cangemi,
  • Roberto Carnevale,
  • Vittoria Cammisotto,
  • Cristina Nocella,
  • Simona Bartimoccia,
  • Gloria Taliani,
  • Marco Falcone,
  • Pasquale Pignatelli,
  • Francesco Violi
Roberto Cangemi
Sapienza University of Rome
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Roberto Carnevale
Sapienza University of Rome
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Vittoria Cammisotto
Universita degli Studi di Roma La Sapienza Facolta di Scienze Matematiche Fisiche e Naturali
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Cristina Nocella
Sapienza University of Rome
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Simona Bartimoccia
sapienza University of Rome
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Gloria Taliani
Sapienza University of Rome
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Marco Falcone
Università degli Studi di Pisa Facolta di Medicina e Chirurgia
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Pasquale Pignatelli
Sapienza University of Rome
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Francesco Violi
Sapienza University of Rome
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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.