Pneumonia in patients with cirrhosis: risk factors associated with mortality and predictive value of prognostic models
Abstract Background Cirrhosis 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 f...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-12-01
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| Series: | Respiratory Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12931-018-0934-5 |
| _version_ | 1818381373333831680 |
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| author | Lichen Xu Shuangwei Ying Jianhua Hu Yunyun Wang Meifang Yang Tiantian Ge Chunhong Huang Qiaomai Xu Haihong Zhu Zhi Chen Weihang Ma |
| author_facet | Lichen Xu Shuangwei Ying Jianhua Hu Yunyun Wang Meifang Yang Tiantian Ge Chunhong Huang Qiaomai Xu Haihong Zhu Zhi Chen Weihang Ma |
| author_sort | Lichen Xu |
| collection | DOAJ |
| description | Abstract Background Cirrhosis 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. Methods Two 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. Results Patients 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. Conclusions This 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). |
| first_indexed | 2024-12-14T02:33:33Z |
| format | Article |
| id | doaj.art-1385a4749f0f4671b90d8c758ec8fc32 |
| institution | Directory Open Access Journal |
| issn | 1465-993X |
| language | English |
| last_indexed | 2024-12-14T02:33:33Z |
| publishDate | 2018-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Respiratory Research |
| spelling | doaj.art-1385a4749f0f4671b90d8c758ec8fc322022-12-21T23:20:11ZengBMCRespiratory Research1465-993X2018-12-0119111110.1186/s12931-018-0934-5Pneumonia in patients with cirrhosis: risk factors associated with mortality and predictive value of prognostic modelsLichen Xu0Shuangwei Ying1Jianhua Hu2Yunyun Wang3Meifang Yang4Tiantian Ge5Chunhong Huang6Qiaomai Xu7Haihong Zhu8Zhi Chen9Weihang Ma10State Key Laboratory for Diagnosis and Treatment of Infectious, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of MedicineDepartment of Hematology, Taizhou Hospital of Zhejiang ProvinceState Key Laboratory for Diagnosis and Treatment of Infectious, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of MedicineState Key Laboratory for Diagnosis and Treatment of Infectious, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of MedicineState Key Laboratory for Diagnosis and Treatment of Infectious, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of MedicineState Key Laboratory for Diagnosis and Treatment of Infectious, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of MedicineState Key Laboratory for Diagnosis and Treatment of Infectious, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of MedicineState Key Laboratory for Diagnosis and Treatment of Infectious, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of MedicineState Key Laboratory for Diagnosis and Treatment of Infectious, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of MedicineState Key Laboratory for Diagnosis and Treatment of Infectious, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of MedicineState Key Laboratory for Diagnosis and Treatment of Infectious, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of MedicineAbstract Background Cirrhosis 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. Methods Two 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. Results Patients 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. Conclusions This 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).http://link.springer.com/article/10.1186/s12931-018-0934-5PneumoniaCirrhosisRisk factorsOutcome |
| spellingShingle | Lichen Xu Shuangwei Ying Jianhua Hu Yunyun Wang Meifang Yang Tiantian Ge Chunhong Huang Qiaomai Xu Haihong Zhu Zhi Chen Weihang Ma Pneumonia in patients with cirrhosis: risk factors associated with mortality and predictive value of prognostic models Respiratory Research Pneumonia Cirrhosis Risk factors Outcome |
| title | Pneumonia in patients with cirrhosis: risk factors associated with mortality and predictive value of prognostic models |
| title_full | Pneumonia in patients with cirrhosis: risk factors associated with mortality and predictive value of prognostic models |
| title_fullStr | Pneumonia in patients with cirrhosis: risk factors associated with mortality and predictive value of prognostic models |
| title_full_unstemmed | Pneumonia in patients with cirrhosis: risk factors associated with mortality and predictive value of prognostic models |
| title_short | Pneumonia in patients with cirrhosis: risk factors associated with mortality and predictive value of prognostic models |
| title_sort | pneumonia in patients with cirrhosis risk factors associated with mortality and predictive value of prognostic models |
| topic | Pneumonia Cirrhosis Risk factors Outcome |
| url | http://link.springer.com/article/10.1186/s12931-018-0934-5 |
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