Chronic Liver Disease Negatively Affects Outcome In Hospitalised Patients With Community-Acquired Pneumonia

We read with great interest the article by Fernandez and colleagues1 which identifies bacterial infections, including pneumonia, not only as a trigger, but also as a common complication of acute-on-chronic liver failure with severe consequences. Moreover, in this and other studies the role of respiratory infections and failure has been shown to be detrimental in patients with chronic liver disease (CLD).2–4 While it is well established that respiratory infections aggravate the clinical outcome and increase mortality in CLD, there are little to no data from large cohorts analysing the role of CLD in patients with community-acquired pneumonia (CAP). This prompted us to analyse the impact of CLD on the severity of CAP using data from the German Competence Network for Community-acquired pneumonia (CAPNETZ) study, a large multicentre study on CAP conducted between 2001 and 2017.5 6 The CAPNETZ study included a total of 11 832 patients with episodes of CAP, of whom 5449 hospitalised patients had information available on the presence or absence of CLD. In this cohort, 289 patients with CAP (5.3%; online supplementary figure S1) were identified with CLD. CAP patients with CLD were significantly younger than those without; their median age (IQR) was 64 years (50–73) vs 73 years (64–80) (pu003c0.001). Possibly due to the lower age in this patient group, cardiac disease, cerebrovascular disease and diabetes mellitus were less frequent in CAP patients with CLD than in those without. By contrast, chronic respiratory diseases were more common …