Outcomes of Patients Hospitalized with Community-Acquired Pneumonia with Liver Disease or Cirrhosis.

Abstract

Introduction: Liver disease and cirrhosis are common causes of mortality worldwide. Community-acquired pneumonia is recognized as a significant cause of morbidity and mortality in this population of adults. There is a lack of data regarding outcomes or prognosis in patients with liver dysfunction who develop CAP. The objective of this study was to evaluate the clinical characteristics, incidence, and outcomes of hospitalized patients with CAP and liver disease. Methods: This was a secondary analysis of the University of Louisville Pneumonia Study, which was a prospective population-based cohort study of adults hospitalized with community-acquired pneumonia. All patients were divided into three groups: 1) patients without liver disease, 2) patients with liver disease, and 3) patients with cirrhosis. Short and long-term outcomes were analyzed. Results: Among 9,201 patients, 8,566 patients did not have liver disease, 515 patients had liver disease, and 120 patients had cirrhosis. The median age of patients with liver disease or cirrhosis was approximately 10 years younger than the median age of overall population, and a higher proportion was admitted directly to the ICU. Compared to patients without liver disease, we found no significant difference in time to clinical stability for patients with liver diseases (adjusted hazard ratio [aHR] 1.01 [95% CI 0.92–1.12]; P=0.790) or cirrhosis (aHR 0.85 [95% CI 0.69–1.05]; P=0.127). There were also no differences in median length of stay (LOS) between any two groups. Patients with cirrhosis had a 35% higher risk of death at any time compared to patients with no liver disease (aHR 1.35 [95% CI 1.00–1.82]; P=0.049) but did not have significantly increased risk compared to patients with liver disease (aHR 1.37 [95% CI 0.97–1.93], P=0.070). Conclusion: In this study of hospitalized adults with CAP, patients with cirrhosis had a significantly higher risk of death compared to patients without liver disease