Pneumonia In Patients With Liver Cirrhosis: Analysis Of Risk Factors For Short-term Mortality And Usefulness Of Severity Scores

Background:Liver cirrhosis is a frequent disease in clinical practice, and is related to increasing economic burden and social impact. Some investigations showed liver cirrhosis is ten most common cause of death worldwide. Infection is very a common complication in patients with liver cirrhosis. Previous researches indicated the mortality in cirrhotic patients who complicated with pneumonia is higher than infection in other sites. Importantly,90-day mortality in cirrhotic patients with pneumonia is 3 fold than those patients without infection. However, the risk factors for short-term mortality in cirrhotic patients with pneumonia was not elucidated in previous records.Aim:1. To compare the clinical features in two separate groups, non-survive group in 90 days and survive group; 2. To investigate the risk factors for short-term mortality in cirrhotic patients with pneumonia; 3. To investigate the usefulness of severity scores that applied to predict the mortality in end-stage liver disease or pneumonia.Methods:204 cirrhotic patients with pneumonia at a tertiary care hospital were included in this retrospective cohort study. Demographic, clinical and laboratory parameters were compared in 90-day survive group and 90-day non-survive group. Multivariate COX regression analysis was used to identify independent predictors of short-term mortality. The usefulness of severity score were compared though ROC curves.Results:of 5767 cirrhotic patients,372 patients occurred pneumonia. Among those patient with pneumonia episode,204 patients were included in this study. The results showed that pneumonia severity index (PSI) level IV-V (HR=2.187,95%CI:1.011-4.728, P=0.047), Child-Pugh level C (HR=6.349,95%CI:2.864-14.052, P< 0.001), inappropriate empiric antibiotic treatment HR=3.624,95%CI:1.938-6.776, P< 0.001) associated with short-term mortality. ROC curve from PSI product an AUC of 0.824 (95% CI:0.753-0.895) and larger than Child-Pugh and MELD model. The sensibility is highest in PSI (0.754), while specificity is highest in Child-Pugh model (0.831).Conclusion:1. Cirrhotic patients with pneumonia in 90 days mortality is as high as 33%, the major pathogen is gram negative bacteria; 2. PSI level IV-V, Child C and inappropriate empiric antibiotic treatment are independent risk factors for short-term mortality.3. PSI is more valuable in predicting short-term mortality and shown higher in sensibility, while Child-Pugh shown higher in specificity.