Ricerc@Sapienza

Community-acquired pneumonia (CAP) is the most common infectious disease leading to hospitalization. Recent studies documented a frequent association between CAP and the occurrence of acute cardiac complications such as heart failure, atrial fibrillation and myocardial infarction. At this regard, we recently showed that CAP is often complicated by elevation of cardiac troponin, a marker of myocardial injury, that can be isolated or associated to myocardial infarction. The importance of these cardiac complications is supported by their prognostic role, as they are associated with an increased short- and long-term mortality.
Glucocorticoids inhibit the expression and action of many cytokines involved in the inflammatory response associated with pneumonia. Recent studies also suggest an anti-platelet effect in this setting. Thus, glucocorticoids could have a potential protective role in preventing myocardial injury and cardiovascular complications in CAP patients.
Primary aim of our study will be to evaluate the effect of systemic glucocorticoids on myocardial injury in a cohort of patients hospitalized for CAP. Secondary aims will be to test their effect on markers of platelet activation and on cardiovascular events during hospitalization, at 30 day from hospital admission and during 2 years¿ follow-up.
To explore this issue, 100 eligible patients will be randomized to a treatment with methylprednisolone 20 mg twice daily ev or placebo for a week from hospital admission.
As troponin elevation is an independent predictor of mortality, a reduction in myocardial injury in patients treated with methylprednisolone will open new perspectives to lower mortality and cardiovascular events.