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 (19952008). 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 636). 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 name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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