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DOI: 10.1055/s-0039-3403298
Impact of chronic liver disease on mortality and severity in community-acquired pneumonia (CAP) – Results from the German Competence Network CAPNETZ
Publication History
Publication Date:
28 February 2020 (online)
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.
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