Context

Pneumonia develops when pathogens invading the sterile lower respiratory tract activate the innate immune response to generate local and systemic inflammation.1 The host's inability to fully downregulate systemic inflammation is the dominant pathogenetic process contributing to acute and long-term morbidity and mortality. In the last decade, we have recognised that, for pneumonia, (1) acute mortality has not improved since the introduction of antibiotics, (2) the heart is a major target organ with more cardiovascular events (particularly for those with atherosclerosis), (3) biological resolution lags weeks behind clinical resolution and (4) most patients discharged from the hospital have subclinical low-grade systemic inflammation and substantial excess mortality for years.1 On the basis of 1-year mortality, pneumonia is the third leading cause of death in the …