Abstract
BackgroundCirrhosis always goes with profound immunity compromise, and makes those patients easily be the target of pneumonia. Cirrhotic patients with pneumonia have a dramatically increased mortality. To recognize the risk factors of mortality and to optimize stratification are critical for improving survival rate.MethodsTwo hundred and three cirrhotic patients with pneumonia at a tertiary care hospital were included in this retrospective study. Demographical, clinical and laboratory parameters, severity models and prognosis were recorded. Multivariate Cox regression analysis was used to identify independent predictors of 30-day and 90-day mortality. Area under receiver operating characteristics curves (AUROC) was used to compare the predictive value of different prognostic scoring systems.ResultsPatients with nosocomial acquired or community acquired pneumonia indicated similar prognosis after 30- and 90-day follow-up. However, patients triggered acute-on-chronic liver failure (ACLF) highly increased mortality (46.4% vs 4.5% for 30-day, 69.6% vs 11.2% for 90-day). Age, inappropriate empirical antibiotic therapy (HR: 2.326 p = 0.018 for 30-day and HR: 3.126 p < 0.001 for 90-day), bacteremia (HR: 3.037 p = 0.002 for 30-day and HR: 2.651 p = 0.001 for 90-day), white blood cell count (WBC) (HR: 1.452 p < 0.001 for 30-day and HR: 1.551 p < 0.001 for 90-day) and total bilirubin (HR: 1.059 p = 0.002 for 90-day) were independent factors for mortality in current study. Chronic liver failure–sequential organ failure assessment (CLIF-SOFA) displayed highest AUROC (0.89 and 0.90, 95% CI: 0.83–0.95 and 0.85–0.95 for 30-day and 90-day respectively) in current study.ConclusionsThis study found age, bacteremia, WBC, total bilirubin and inappropriate empirical antibiotic therapy were independently associated with increased mortality. Pneumonia triggered ACLF remarkably increased mortality. CLIF-SOFA was more accurate in predicting mortality than other five prognostic models (model for end-stage liver disease (MELD), MELD-Na, quick sequential organ failure assessment (qSOFA), pneumonia severity index (PSI), Child-Turcotte-Pugh (CTP) score).
Highlights
Cirrhosis is one of the most common causes of mortality worldwide especially in developing countries, with 1-year mortality ranging from 1 to 57% depending on stage [1]
Infectious complications increased mortality 4-fold in cirrhotic patients, 30% patients died within 30-day and another 30% died within 1 year after infection [3, 4]
In a infectious disease survey of 4576 cirrhotic patients, pneumonia had a 2.95-fold increase in 30-day mortality, the highest among all infection complications
Summary
Cirrhosis is one of the most common causes of mortality worldwide especially in developing countries, with 1-year mortality ranging from 1 to 57% depending on stage [1]. Infectious diseases are common in patients with advanced cirrhosis and exert one of most important reasons for mortality. Infectious complications increased mortality 4-fold in cirrhotic patients, 30% patients died within 30-day and another 30% died within 1 year after infection [3, 4]. Pneumonia is a common infectious disease in patients with cirrhosis [5, 6]. In a infectious disease survey of 4576 cirrhotic patients, pneumonia had a 2.95-fold increase in 30-day mortality, the highest among all infection complications [7] In patients with care unit acquired pneumonia, cirrhosis worsen clinical outcome and increased 28-day mortality as high as 11-fold [8]. To recognize the risk factors of mortality and to optimize stratification are critical for improving survival rate
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