Pneumologie 2020; 74(S 01): 107
DOI: 10.1055/s-0039-3403298
Posterbegehung (PO21) – Sektion Infektiologie und Tuberkulose
Pneumologische Infektiologie
Georg Thieme Verlag KG Stuttgart · New York

Impact of chronic liver disease on mortality and severity in community-acquired pneumonia (CAP) – Results from the German Competence Network CAPNETZ

C Bellinghausen
1   Medical Clinic I, Department of Respiratory Medicine, University Hospital Frankfurt
,
M Pletz
2   Institute for Infectious Diseases and Infection Control, Jena University Hospital; Capnetz Foundation, Hannover
,
J Rupp
3   Department of Infectious Diseases and Microbiology, University Hospital Schleswig Holstein, Lübeck; Capnetz Foundation, Hannover
,
M Witzenrath
4   Department of Infectious Diseases and Pulmonary Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin; Capnetz Foundation, Hannover
,
C Welsch
5   Medical Clinic I, Department of Hepatology, University Hospital Frankfurt
,
S Zeuzem
5   Medical Clinic I, Department of Hepatology, University Hospital Frankfurt
,
J Trebicka
6   Medical Clinic I, Department of Hepatology, University Hospital Frankfurt; European Foundation for Study of Chronic Liver Failure, Efclif, Barcelona, Spain
,
G Rohde
7   Medical Clinic I, Department of Respiratory Medicine, University Hospital Frankfurt; Capnetz Foundation, Hannover; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (Breath), Member of the German Center for Lung Research (Dzl)
› Author Affiliations
Further Information

Publication History

Publication Date:
28 February 2020 (online)

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Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality, and the most frequent reason for hospital admission due to respiratory disease. The course of CAP can be aggravated by chronic underlying disease. Aim of this study was to analyse the impact of chronic liver disease on the severity and outcome of CAP.

We conducted a secondary analysis of the CAPNETZ study, which collected clinical and laboratory data from patients with CAP between 2001 and 2017. All cases in which the presence/absence of chronic liver disease was documented (n = 6169) were included in this analysis. Mortality rates were analysed using univariate and multivariate binary logistic regression.

Chronic liver disease was documented in 351 (5.7%) of cases. Despite significantly younger age (median 63 years, interquartile range (IQR) 49 – 73 vs. 72 years, IQR 63 – 80, p < 0.001) and a lower prevalence of other major co-morbidities, 30-day mortality was higher in CAP patients with chronic liver disease (9.2% vs. 6.3%, odds ratio (OR) 1.55, 95% confidence interval (CI) 1.02 – 2.33). This difference was particularly pronounced in hospitalised patients (11.2% vs. 7.1%, OR 1.61, 95%CI 1.11 – 2.48). Adjusted for age, BMI, and the presence of heart failure and diabetes mellitus in multivariate analysis, the OR of 30-day mortality was 2.75 (1.73 – 4.37) in CAP-patients with chronic liver disease compared to those without. CURB or CRB-65 scores, were similar or even less severe in patients with chronic liver disease, and did thus not adequately reflect the increased mortality risk in chronic liver disease. The most commonly detected pathogens in both groups were Streptococcus pneumoniae, Mycoplasma pneumoniae and Legionella spp. Positive blood cultures were more frequent in patients with chronic liver disease than in those without (17.5% vs. 8.6%, OR 2.26, 95%CI 1.40 – 3.66). Of patients with chronic liver disease, 16.3% fulfilled two or more qSOFA criteria, together with their suspected infection indicating a high risk for sepsis (vs. 11.7% in patients without chronic liver disease, OR 1.48, 95%CI 1.08 – 2.01).

These data show that chronic liver disease is associated with increased mortality and a more severe course in CAP, which is not adequately reflected by commonly used risk assessments for CAP.