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Chronic liver disease negatively affects outcome in hospitalised patients with community-acquired pneumonia
  1. Carla Bellinghausen1,
  2. Mathias W Pletz2,3,
  3. Jan Rupp3,4,
  4. Martin Witzenrath3,5,
  5. Christoph Welsch6,
  6. Stefan Zeuzem7,
  7. Jonel Trebicka6,8,
  8. Gernot G U Rohde1,9
  9. Members of the CAPNETZ study group
    1. 1 University Hospital Frankfurt - Department of Respiratory Medicine and Allergology, Goethe University Frankfurt, Frankfurt am Main, Germany
    2. 2 Institute for Infectious Diseases and infection Control, Jena University Hospital, Jena, Thüringen, Germany
    3. 3 CAPNETZ Foundation, Hannover, Germany
    4. 4 Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, Schleswig-Holstein, Germany
    5. 5 Department of Infectious Diseases and Pulmonary Medicine, Charite University Hospital Berlin, Berlin, Germany
    6. 6 University Hospital Frankfurt - Medical Clinic I - Department of Hepatology, Goethe University Frankfurt, Frankfurt am Main, Germany
    7. 7 University Hospital Frankfurt - Medical Clinic I, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
    8. 8 European Foundation for the Study of Chronic Liver Failure, Barcelona, Catalunya, Spain
    9. 9 CAPNETZ Foundation, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
    1. Correspondence to Dr Jonel Trebicka, University Hospital Frankfurt - Medical Clinic I - Department of Hepatology, Goethe University Frankfurt, Frankfurt am Main 60323, Germany; Jonel.Trebicka{at}

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    We read with great interest the article by Fernández 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) (p<0.001). 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 …

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    • Collaborators Members of the CAPNETZ study group: M Dreher, C Cornelissen (Medical Clinic I, University Clinic RWTH Aachen); W Knüppel (Clinic for Internal Medicine, Hospital Bad Arolsen); D Stolz (Clinic for Pneumology, Uni-Spital Basel, Switzerland); N Suttorp, P Creutz, M Witzenrath, A Mikolajewska, A le Claire, M Benzke (Department of Infectious Disease and Respiratory Medicine, Charité-University Medicine, Berlin); T Bauer, D Krieger (HELIOS Klinikum Emil von Behring, Berlin); M Prediger, S Schmager (III. Medical Clinic, Carl-Thiem-Klinikum Cottbus); M Kolditz, B Schulte-Hubbert, S Langner (Medical Department I, Division of Pulmonology, University Hospital Dresden); G Rohde (Medical Clinic I – Pneumology/Allergology, University Hospital Frankfurt); O Degen, A Hüfner (Outpatient Center, University Hospital Hamburg-Eppendorf); C Hoffmann (ICH Study Center, Hamburg); T Welte, J Freise (Department of Respiratory Medicine, Hannover Medical School, Hanover); G Barten-Neiner, M Nawrocki, I Fuge, J Naim, W Kröner (CAPNETZ Office, Hannover); T Illig, N Klopp (Hannover Unified Biobank); C Kroegel, A Moeser (Department of Pneumology & Allergy/Immunology, University Hospital Jena); M Pletz, B Schleenvoigt, C Forstner (Centre for Infection Medicine and Hospital Hygiene (ZIMK), University Hospital, Jena); D Drömann, P Parschke, K Franzen (Med Clinic III, Pulmology, University Hospital Schleswig-Holstein, Lübeck); J Rupp, N Käding (Department of Infectiology and Microbiology, University Hospital Schleswig-Holstein, Lübeck); M Wouters, K Walraven, D Braeken (Department of Respiratory Medicine, Maastricht University Medical Center-MUMC+, Maastricht, The Netherlands); C Spinner (Clinic for Pneumology and General Internal Medicine, Rechts der Isar Hospital, Munich); H Buschmann, A Zaruchas (Medical Clinic-Pneumology, Brüderkrankenhaus St Josef, Paderborn); T Schaberg, I Hering (Center of Pneumology, Diakonie-Hospital Rotenburg); W Albrich, F Waldeck, F Rassouli, S Baldesberger (Department of Infectiology and Hospital Hygiene, Kantonsspital St Gallen, Switzerland); M Panning (University Medical Center Freiburg, Institute of Virology); M Wallner (2mt Software, Ulm); and all study nurses.

    • Contributors Study concept and design: CB, MWP, JR, MW, JT, GGUR. Acquisition, analysis or interpretation of data: CB, MWP, JR, MW, CW, SZ, JT, GGUR. Drafting of the manuscript: CB, JT, GGUR. Critical revision of the manuscript for intellectual content: MWP, JR, MW, CW, SZ.

    • Funding CAPNETZ was funded by a grant from the German Federal Ministry of Education and Research (BMBF grant 01KI07145) 2001–2011.

    • Competing interests MW received research funding outside the submitted work from Biotest, Boehringer Ingelheim, Noxxon, Quark Pharma, Silence Therapeutics and Vaxxilon, and personal fees for lectures or counselling from Actelion, AstraZeneca, Bayer HealthCare, Berlin Chemie, Biotest, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis and Vaxxilon. SZ received consultancy and/or lecture honoraria from AbbVie, Allergan, Intercept, Janssen, Gilead and Merck/MSD. JT received speaking and/or consulting fees from Gore, Bayer, Alexion, MSD, Gilead, Intercept, Norgine, Grifols, Versantis and Martin Pharmaceutical, all unrelated to the submitted work. GGUR reports personal fees from Pfizer, Boehringer Ingelheim, Solvay, GSK, Essex Pharma, MSD, Grifols, Chiesi, Vertex, Roche, Insmed and Novartis for lectures including service on speakers' bureaus outside the submitted work and/or consultancy during advisory board meeting, and personal fees from GSK for travel accommodations/meeting expenses outside the submitted work.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.