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Epidemiology, clinical features, and outcomes of community-acquired pneumonia in patients with liver cirrhosis

Abstract number: P1344

Viasus D., Garcia-Vidal C., Castellote J., Adamuz J., Verdaguer R., Gudiol F., Carratalà J.

Objective: Although liver cirrhosis is associated with an increased susceptibility to infection, little information is available regarding community-acquired pneumonia (CAP) in this setting. We aimed to ascertain epidemiology, clinical features, and outcomes of CAP in patients with liver cirrhosis. The prognostic value of several specific-disease scores was also analyzed.

Methods: Observational analysis of a prospective cohort of nonseverely immunosuppressed hospitalized adults with CAP (1995–2008). Liver cirrhosis was diagnosed by histology or by clinical, laboratory and imaging criteria.

Results: We documented 3421 CAP episodes, of which 90 cases occurred in patients with liver cirrhosis. The median value of model for end-stage liver disease (MELD) was 14 (range 6–36). According to the Child-Pugh (CP) score, 56% of patients were grade B and 21% grade C. Patients with liver cirrhosis were younger (61.4 vs 66.3 years; p = 0.001), more often male (80% vs 68%; p = 0.021), current smokers (41% vs 26%; p = 0.002) and heavy alcohol drinkers (35% vs 17%; p < 0.001) than the remaining patients. They had more frequently altered mental status at admission (33% vs 13%; p < 0.001), shock (13% vs 6%; p = 0.011), and were more commonly classified into high-risk pneumonia severity index (PSI) classes (group IV-V) (74% vs 57%; p = 0.002). Streptococcus pneumoniae (46% vs 33%; p = 0.009) and Pseudomonas aeruginosa (4.4% vs 0.9%: p = 0.001) were more frequently documented in patients with liver cirrhosis. Bacteraemia was also more common among these patients (21% vs 13%; p = 0.023). Specific-disease scores were comparable in predicting severe disease (30-day mortality and/or ICU admission); area under the ROC curve were 0.83 (MELD), 0.75 (CURB-65), 0.74 (CP), and 0.70 (PSI). Early (<48 h) (5.6% vs 2.1%; p < 0.048) and 30-day mortality rates (14.4% vs 7.4%; p < 0.024) were higher in patients with liver cirrhosis.

Conclusions: CAP is associated with a poor outcome in patients with liver cirrhosis. Specific-disease scores, especially MELD, may help identify patients at high risk of adverse outcomes. Strategies aimed to improve the management of CAP in liver cirrhosis patients are needed.

Session Details

Date: 10/04/2010
Time: 00:00-00:00
Session name: Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Vienna, Austria, 10 - 13 April 2010
Presentation type:
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