title: Risk factors and clinical characteristics associated with hospitalization for community-acquired bacterial pneumonia in HIV-positive patients according to the presence of liver cirrhosis.
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 abuse were 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Dept. of Infectious and Tropical Diseases, University of Brescia, Piazzale Spedali Civili 1, Brescia, Italy. danymanno@libero.it
authors.forename: D
authors.initials: D
authors.lastname: Manno
authors.forename: M
authors.initials: M
authors.lastname: Puoti
authors.forename: L
authors.initials: L
authors.lastname: Signorini
authors.forename: G
authors.initials: G
authors.lastname: Lapadula
authors.forename: B
authors.initials: B
authors.lastname: Cadeo
authors.forename: L
authors.initials: L
authors.lastname: Soavi
authors.forename: G
authors.initials: G
authors.lastname: Paraninfo
authors.forename: R
authors.initials: R
authors.lastname: Allegri
authors.forename: G
authors.initials: G
authors.lastname: Cristini
authors.forename: P
authors.initials: P
authors.lastname: Viale
authors.forename: G
authors.initials: G
authors.lastname: Carosi
mesh_terms: D000328:Adult; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology*; D012307:Risk Factors