Impact of liver cirrhosis on the clinical profile and outcomes in community-acquired pneumonia: A systematic review

Abstract

Objective: Community-acquired pneumonia (CAP) is a serious infection in patients with cirrhosis. This study aimed to describe clinical features of patients with cirrhosis and CAP, and to determinate whether cirrhosis is consistently associated with poor outcomes. Methods: Databases were systematically searched for full-text articles comparing patients with and without cirrhosis with CAP and evaluating the impact of cirrhosis on clinical profile and outcomes, from inception to February 2021. Results: Totals of 1485 and 114740 patients with cirrhosis and without cirrhosis with CAP were included, respectively. Patients with cirrhosis had different characteristics and more severe disease at admission compared to patients without cirrhosis (hypotension, altered mental status, hyponatremia, hypoalbuminemia were more frequent in patients with cirrhosis). Streptococcus pneumoniae was more frequently identified as the causative pathogen of CAP in patients with cirrhosis, and bloodstream infections were also more common. Likewise, risk of intensive care unit admission and mortality was higher in patients with cirrhosis than in patients without cirrhosis (range 11.1%-23.3% versus 8.8%-17.2% and 2.7%-23% compared with 14.4%-34.5%, respectively). Discussion: Patients with cirrhosis and CAP have a poorer prognosis than patients without cirrhosis. Information on the clinical features of CAP in patients with cirrhosis and on risk factors for poor outcomes remains limited.