Infection

, Volume 37, Issue 4, pp 334–339

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

  • D. Manno
  • M. Puoti
  • L. Signorini
  • G. Lapadula
  • B. Cadeo
  • L. Soavi
  • G. Paraninfo
  • R. Allegri
  • G. Cristini
  • P. Viale
  • G. Carosi
Clinical and Epidemiological Study

DOI: 10.1007/s15010-009-8140-5

Cite this article as:
Manno, D., Puoti, M., Signorini, L. et al. Infection (2009) 37: 334. doi:10.1007/s15010-009-8140-5

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.

Copyright information

© Springer 2009

Authors and Affiliations

  • D. Manno
    • 1
  • M. Puoti
    • 1
  • L. Signorini
    • 1
  • G. Lapadula
    • 1
  • B. Cadeo
    • 2
  • L. Soavi
    • 1
  • G. Paraninfo
    • 1
  • R. Allegri
    • 3
  • G. Cristini
    • 3
  • P. Viale
    • 2
  • G. Carosi
    • 1
  1. 1.Dept. of Infectious and Tropical DiseasesUniversity of BresciaBresciaItaly
  2. 2.Dept. of Infectious DiseasesUniversity of UdineUdineItaly
  3. 3.1st Dept. of Infectious DiseasesA.O. Spedali CiviliBresciaItaly

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