Corticosteroid use, myocardial injury and in-hospital cardiovascular events in patients with community-acquired pneumonia

Link to article at PubMed

Br J Clin Pharmacol. 2021 Jun 4. doi: 10.1111/bcp.14936. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Corticosteroids are often prescribed to community acquired pneumonia (CAP) patients, but the relationship with major cardiovascular events (MACE) is unclear.

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). Age, heart failure and the increasing quintiles of hs-cTnT (HR: 2.16; 95% CI: 1.82-2.58; p<0.001) predicted MACE. Among patients with hs-cTnT >0.014 μg/L at admission, 102 patients (31%) were on corticosteroids and showed lower hs-cTnT increase (p=0.021), Nox2 activation (p=0.005) and incidence of MACE than untreated ones [HR: 0.64; 95% CI: 0.41-0.97; p=0.038]; no effect of corticosteroids on MACE was observed in CAP patients with normal troponin. In vitro study showed that glucocorticoids have an antioxidant effect via down-regulation of Nox2 activity.

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.

PMID:34087003 | DOI:10.1111/bcp.14936

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