Pneumonia in patients with cirrhosis: risk factors associated with mortality and predictive value of prognostic models

Abstract

BackgroundCirrhosis always goes with profound immunity compromise, and makes those patients easily be the target of pneumonia. Cirrhotic patients with pneumonia have a dramatically increased mortality. To recognize the risk factors of mortality and to optimize stratification are critical for improving survival rate.MethodsTwo hundred and three cirrhotic patients with pneumonia at a tertiary care hospital were included in this retrospective study. Demographical, clinical and laboratory parameters, severity models and prognosis were recorded. Multivariate Cox regression analysis was used to identify independent predictors of 30-day and 90-day mortality. Area under receiver operating characteristics curves (AUROC) was used to compare the predictive value of different prognostic scoring systems.ResultsPatients with nosocomial acquired or community acquired pneumonia indicated similar prognosis after 30- and 90-day follow-up. However, patients triggered acute-on-chronic liver failure (ACLF) highly increased mortality (46.4% vs 4.5% for 30-day, 69.6% vs 11.2% for 90-day). Age, inappropriate empirical antibiotic therapy (HR: 2.326 p = 0.018 for 30-day and HR: 3.126 p < 0.001 for 90-day), bacteremia (HR: 3.037 p = 0.002 for 30-day and HR: 2.651 p = 0.001 for 90-day), white blood cell count (WBC) (HR: 1.452 p < 0.001 for 30-day and HR: 1.551 p < 0.001 for 90-day) and total bilirubin (HR: 1.059 p = 0.002 for 90-day) were independent factors for mortality in current study. Chronic liver failure–sequential organ failure assessment (CLIF-SOFA) displayed highest AUROC (0.89 and 0.90, 95% CI: 0.83–0.95 and 0.85–0.95 for 30-day and 90-day respectively) in current study.ConclusionsThis study found age, bacteremia, WBC, total bilirubin and inappropriate empirical antibiotic therapy were independently associated with increased mortality. Pneumonia triggered ACLF remarkably increased mortality. CLIF-SOFA was more accurate in predicting mortality than other five prognostic models (model for end-stage liver disease (MELD), MELD-Na, quick sequential organ failure assessment (qSOFA), pneumonia severity index (PSI), Child-Turcotte-Pugh (CTP) score).Electronic supplementary materialThe online version of this article (10.1186/s12931-018-0934-5) contains supplementary material, which is available to authorized users.

Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie – Update 2021

“…Ebenso kann sich eine chronische Leberinsuffizienz verschlechtern [8,190]. Deshalb sollten bei Aufnahme im Labor die Transaminasen und Cholestaseparameter bestimmt werden.…”

Spectrum of respiratory viral infectionsin liver disease patients with cirrhosis admitted in critical care unit

“…Pneumonia is one of the most common infections in liver disease patients with cirrhosis admitted in CCU. [1,2] The prevalence of pneumonia is reported in about 21.4% of cirrhotic patients with mortality rates as high as 37%-41%. [3] There are several consequences of pneumonia in cirrhotic patients which include acute on chronic liver failure, multiple organ failure, sepsis, prolonged hospitalization, and mortality.…”

Safety of laparoscopic pancreaticoduodenectomy in patients with liver cirrhosis using propensity score matching

“…Patients with chronic liver diseases are at high risk of contracting infections, due to increased bacterial translocation and immune suppression associated with decreased liver function [ 35 ]. For instance, pneumonia is a common infectious disease in cirrhotic patients [ 36 , 37 ]. In the current study, cirrhotic patients showed significantly higher morbidity of postoperative pulmonary infection compared with patients in the control group.…”