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Risk Factors and Clinical Characteristics Associated with Hospitalization for Community-Acquired Bacterial Pneumonia in HIV-Positive Patients According to the Presence of Liver Cirrhosis

  • Clinical and Epidemiological Study
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Abstract

Background:

Community-acquired bacterial pneumonia (CABP) represents an important cause of morbidity and mortality for cirrhotic and HIV-infected patients, respectively. However, little is known on CABP in HIV-positive patients with cirrhosis. A study was performed to describe the clinical features and factors predictive of mortality and prolonged hospitalization in cirrhotic HIV-infected patients with a diagnosis of CABP.

Methods:

Demographic and clinical characteristics of cirrhotic HIV-positive subjects, hospitalized for CABP in our department from June 2000 to December 2006, were compared with those of non-cirrhotic HIV-infected patients with the same diagnosis hospitalized from June 2000 to November 2001. Variables with p < 0.10 in univariate analysis were tested for their predictive value for mortality and length of hospitalization with uni- and multivariate logistic regression analysis.

Results:

Twenty-nine cirrhotic and 73 non-cirrhotic HIV-positive patients with CABP were compared. Age and alcohol abusewere significantly higher in cirrhotics. At hospital admission, cirrhotic patients had more frequently mental status alterations (7.26 [2.21–23.82], p = 0.001) and milder symptoms and signs (temperature > 37.5 _C: 0.27 [0.10–0.75], p = 0.01; respiratory rate > 20: 0.34 [0.13–0.92], p = 0.033; systemic inflammatory response syndrome (SIRS): 0.39 [0.16–0.95], p = 0.038). Adjusting for age, cirrhosis was associated with a higher mortality (5.96 [1.05–33.57]; p = 0.043). Adjusting for age, gender, and concomitant antiretroviral treatment, cirrhosis was also associated with a prolonged hospitalization (> 7 days: 9.30 [1.84–46.82]; p = 0.007).

Conclusion:

The diagnosis of CABP can be difficult in cirrhotic HIV-positive patients because clinical presentation is milder. However, CABP needs to be promptly recognized because mortality is higher in these patients.

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Authors and Affiliations

  1. Dept. of Infectious and Tropical Diseases, University of Brescia, P.zzle Spedali Civili 1, 25123, Brescia, Italy

    D. Manno, M. Puoti, L. Signorini, G. Lapadula, L. Soavi, G. Paraninfo & G. Carosi

  2. Dept. of Infectious Diseases, University of Udine, Udine, Italy

    B. Cadeo & P. Viale

  3. 1st Dept. of Infectious Diseases, A.O. Spedali Civili, Brescia, Italy

    R. Allegri & G. Cristini

Authors
  1. D. Manno
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  2. M. Puoti
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  3. L. Signorini
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  4. G. Lapadula
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  5. B. Cadeo
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  6. L. Soavi
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  7. G. Paraninfo
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  8. R. Allegri
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  9. G. Cristini
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  10. P. Viale
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  11. G. Carosi
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Correspondence to D. Manno.

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Manno, D., Puoti, M., Signorini, L. et al. Risk Factors and Clinical Characteristics Associated with Hospitalization for Community-Acquired Bacterial Pneumonia in HIV-Positive Patients According to the Presence of Liver Cirrhosis. Infection 37, 334–339 (2009). https://doi.org/10.1007/s15010-009-8140-5

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  • DOI: https://doi.org/10.1007/s15010-009-8140-5

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