Risk factors and mortality in patients with pneumonia and elevated troponin levels

December 10, 2020


Pneumonia in hospitalized patients is associated with myocardial injury. In this study, we evaluated risk factors for myocardial injury in hospitalized patients with pneumonia and its prognostic value. We retrieved all patients who were hospitalized in internal medicine departments in a tertiary medical center between 2008 and 2019 with a diagnosis of pneumonia.

From 2008 to 2019 a total of 20,683 adult patients were hospitalized in internal medicine wards in the Sheba Medical Center with a diagnosis of pneumonia, 8195 were tested for troponin levels, and 3207 had elevated levels. Risk factors for elevated troponin levels were age, prior diagnosis of ischemic heart disease, and elevated creatinine level upon admission. The in-hospital mortality and 1-year mortality rate were higher among patients who had elevated troponin levels when using a propensity score-based matched analysis. In conclusion, in hospitalized patients with pneumonia elevated troponin levels have a major impact on prognosis. Hence, troponin levels may be used as another tool of risk stratification for patients hospitalized with pneumonia.


Pneumonia is a common worldwide infectious disease that is associated with a high hospitalization rate and mortality. Although pneumonia is an acute condition, the long-term effects of this disease are significant3.

Several studies have demonstrated the association between pneumonia and the risk of future cardiac complications. Pneumonia has been shown to predispose to several cardiac conditions including heart failure, cardiac arrhythmia and myocardial infarction (MI). Among patients hospitalized with pneumonia, 2.3–7% were reported with concurrent MI. The incidence of MI surges to 15% in patients with severe pneumonia and to 20% in pneumonia patients who experienced clinical failure. The risk for MI among pneumonia patients is most common during the 15 days following the diagnosis of pneumonia, with the highest risk within the first 3 days. The proposed mechanisms underlying the triggers of acute MI in pneumonia include hypoxemia, increased sympathetic activity, increased inflammatory activity within coronary atherosclerotic plaques and endothelial dysfunction.

The in-hospital mortality rate of pneumonia patients with MI is substantial. In a study conducted by Aliberti et al., it was reported that the mortality rate was significantly higher among patients who have had an MI following pneumonia (43%) than among those who developed other cardiovascular events (21%). Another study demonstrated that the mortality rate remains high even in a follow-up of 2 years.

Endeavors have been made to identify pneumonia patients who are at a greater risk for developing cardiovascular events. Several factors have been suggested including old age, previous cardiac history, and severe pneumonia. Further research has pointed to factors specifically linked to higher risk for MI: female sex, liver disease and the presence of severe sepsis6.

Previous research focusing on acute MI in pneumonia patients has been limited to a relatively small cohort. The aims of our study were (1) to evaluate the incidence of acute myocardial injury in hospitalized patients with pneumonia, (2) to investigate risk factors for acute cardiovascular events following pneumonia, (3) and to determine the short and long term outcomes for this population. In our research, we used a large database from the biggest tertiary hospital in Israel, comprising of 8195 pneumonia patients who were also tested for troponin I levels.

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