Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://gr.elmerpub.com

Original Article

Volume 19, Number 2, April 2026, pages 55-63

Burden and Impact of Pneumococcal Pneumonia on Outcomes in Patients With Cirrhosis: A Nationwide Analysis

↓ Figure 1. Clinical outcomes among hospitalized patients with cirrhosis, stratified by the presence of pneumococcal pneumonia. Patients with cirrhosis and pneumococcal pneumonia experienced significantly worse clinical outcomes compared with those without pneumococcal pneumonia, including higher rates of in-hospital mortality, shock, intensive care unit admission, acute kidney injury, and non-home discharge (P < 0.001 for all outcomes).

↓ **Table 1.** Patient and Hospital Characteristics Among Hospitalized Patients With Cirrhosis, Stratified by the Presence of Pneumococcal Pneumonia
Patient and hospital characteristics	Absence of pneumococcal pneumonia, n (%)	Presence of pneumococcal pneumonia, n (%)	P-value
n (%): number of patients in each group (percentage of patients).
Age category			< 0.001
18–44	536,750 (11.6)	9,235 (10.2)
45–64	2,348,644 (50.8)	45,215 (49.9)
> 65	1,740,789 (37.6)	36,230 (39.9)
Sex			< 0.001
Males	2,767,419 (59.8)	56,300 (62.1)
Females	1,858,764 (40.2)	34,380 (37.9)
Race			< 0.001
White	3,059,494 (66.1)	61,955 (68.3)
Black	482,105 (10.4)	9,060 (9.9)
Hispanic	784,890 (17.0)	12,930 (14.3)
Asian/Pacific Islander	96,610 (2.1)	1,855 (2.0)
Native American	75,325 (1.6)	2,065 (2.3)
Other	127,760 (2.8)	2,815 (3.1)
Primary expected payer			< 0.001
Medicare	2,190,794 (47.4)	45,415 (50.1)
Medicaid	1,169,564 (25.3)	23,740 (26.2)
Private	856,705 (18.5)	14,540 (16.0)
Uninsured	251,155 (5.4)	3,900 (4.3)
Median household income			< 0.001
Lowest quartile	1,578,189 (34.1)	33,485 (36.9)
Second quartile	1,231,645 (26.6)	24,895 (27.5)
Third quartile	1,061,520 (23.0)	19,655 (21.7)
Highest quartile	754,830 (16.3)	12,645 (13.9)
Region of hospital			< 0.001
Northeast	791,304 (17.1)	14,015 (15.5)
Midwest	904,525 (19.6)	20,330 (22.4)
South	1,872,060 (40.5)	36,945 (40.7)
West	1,058,294 (22.9)	19,390 (21.4)
Teaching status of the hospitals			0.01
Non-teaching hospitals	1,214,614 (26.3)	24,755 (27.3)
Teaching hospitals	3,411,569 (73.7)	65,925 (72.7)
Bed size of hospital			< 0.001
Small	910,688 (19.7)	16,415 (18.1)
Medium	1,329,269 (28.7)	25,655 (28.3)
Large	2,386,226 (51.6)	48,610 (53.6)

↓ Table 1. Patient and Hospital Characteristics Among Hospitalized Patients With Cirrhosis, Stratified by the Presence of Pneumococcal Pneumonia

Patient and hospital characteristics

Absence of pneumococcal pneumonia, n (%)

Presence of pneumococcal pneumonia, n (%)

P-value

n (%): number of patients in each group (percentage of patients).

Age category

< 0.001

18–44

536,750 (11.6)

9,235 (10.2)

45–64

2,348,644 (50.8)

45,215 (49.9)

> 65

1,740,789 (37.6)

36,230 (39.9)

Sex

< 0.001

Males

2,767,419 (59.8)

56,300 (62.1)

Females

1,858,764 (40.2)

34,380 (37.9)

Race

< 0.001

White

3,059,494 (66.1)

61,955 (68.3)

Black

482,105 (10.4)

9,060 (9.9)

Hispanic

784,890 (17.0)

12,930 (14.3)

Asian/Pacific Islander

96,610 (2.1)

1,855 (2.0)

Native American

75,325 (1.6)

2,065 (2.3)

Other

127,760 (2.8)

2,815 (3.1)

Primary expected payer

< 0.001

Medicare

2,190,794 (47.4)

45,415 (50.1)

Medicaid

1,169,564 (25.3)

23,740 (26.2)

Private

856,705 (18.5)

14,540 (16.0)

Uninsured

251,155 (5.4)

3,900 (4.3)

Median household income

< 0.001

Lowest quartile

1,578,189 (34.1)

33,485 (36.9)

Second quartile

1,231,645 (26.6)

24,895 (27.5)

Third quartile

1,061,520 (23.0)

19,655 (21.7)

Highest quartile

754,830 (16.3)

12,645 (13.9)

Region of hospital

< 0.001

Northeast

791,304 (17.1)

14,015 (15.5)

Midwest

904,525 (19.6)

20,330 (22.4)

South

1,872,060 (40.5)

36,945 (40.7)

West

1,058,294 (22.9)

19,390 (21.4)

Teaching status of the hospitals

0.01

Non-teaching hospitals

1,214,614 (26.3)

24,755 (27.3)

Teaching hospitals

3,411,569 (73.7)

65,925 (72.7)

Bed size of hospital

< 0.001

Small

910,688 (19.7)

16,415 (18.1)

Medium

1,329,269 (28.7)

25,655 (28.3)

Large

2,386,226 (51.6)

48,610 (53.6)

↓ **Table 2.** Underlying Liver Disease and Liver-Related Decompensations Among Patients With Cirrhosis, Stratified by the Presence of Pneumococcal Pneumonia
	Absence of pneumococcal pneumonia, n (%)	Presence of pneumococcal pneumonia, n (%)	P-value
n (%): number of patients in each group (percentage of patients).
Underlying liver disease
Alcohol-associated liver disease	2,112,164 (45.7)	38,800 (42.8)	< 0.001
Hepatitis C	831,415 (18.0)	17,155 (18.9)	< 0.001
Hepatitis B	93,950 (2.0)	2,065 (2.3)	0.02
Metabolic dysfunction- associated steatohepatitis	605,930 (13.1)	8,920 (9.8)	< 0.001
Autoimmune liver disease	52,645 (1.1)	815 (0.9)	0.003
Cholestatic liver disease	48,750 (1.1)	735 (0.8)	0.001
Hepatocellular carcinoma	186,835 (4.0)	2,400 (2.6)	< 0.001
Decompensations
Hepatic encephalopathy	454,930 (9.8)	22,510 (24.8)	< 0.001
Ascites	1,923,684 (41.6)	33,925 (37.4)	< 0.001
Hepatorenal syndrome	230,100 (5.0)	5,990 (6.6)	< 0.001
Variceal bleeding	259,035 (5.6)	3,710 (4.1)	< 0.001

↓ Table 2. Underlying Liver Disease and Liver-Related Decompensations Among Patients With Cirrhosis, Stratified by the Presence of Pneumococcal Pneumonia

Absence of pneumococcal pneumonia, n (%)

Presence of pneumococcal pneumonia, n (%)

P-value

n (%): number of patients in each group (percentage of patients).

Underlying liver disease

Alcohol-associated liver disease

2,112,164 (45.7)

38,800 (42.8)

< 0.001

Hepatitis C

831,415 (18.0)

17,155 (18.9)

< 0.001

Hepatitis B

93,950 (2.0)

2,065 (2.3)

0.02

Metabolic dysfunction- associated steatohepatitis

605,930 (13.1)

8,920 (9.8)

< 0.001

Autoimmune liver disease

52,645 (1.1)

815 (0.9)

0.003

Cholestatic liver disease

48,750 (1.1)

735 (0.8)

0.001

Hepatocellular carcinoma

186,835 (4.0)

2,400 (2.6)

< 0.001

Decompensations

Hepatic encephalopathy

454,930 (9.8)

22,510 (24.8)

< 0.001

Ascites

1,923,684 (41.6)

33,925 (37.4)

< 0.001

Hepatorenal syndrome

230,100 (5.0)

5,990 (6.6)

< 0.001

Variceal bleeding

259,035 (5.6)

3,710 (4.1)

< 0.001

↓ **Table 3.** Comorbidities Among Patients With Cirrhosis, Stratified by the Presence of Pneumococcal Pneumonia
Comorbidities	Absence of pneumococcal pneumonia, n (%)	Presence of pneumococcal pneumonia, n (%)	P-value
n (%): number of patients in each group (percentage of patients).
Renal failure	1,234,195 (26.7)	25,270 (27.9)	< 0.001
Heart failure	1,121,440 (24.2)	31,185 (34.4)	< 0.001
Coronary artery disease	779,060 (16.8)	15,175 (16.7)	0.71
Chronic obstructive pulmonary disease	898,120 (19.4)	33,175 (36.6)	< 0.001
Alcohol use	2,354,424 (50.9)	43,575 (48.1)	< 0.001
Obesity	785,375 (17.0)	15,275 (16.8)	0.65
Smoking	2,159,469 (46.7)	38,890 (42.9)	< 0.001
Hyperlipidemia	1,203,495 (26.0)	21,145 (23.3)	< 0.001
Hypertension	1,466,824 (31.7)	22,635 (25.0)	< 0.001
Diabetes	1,641,819 (35.5)	37,870 (41.8)	< 0.001
Modified Charlson Comorbidity Index			< 0.001
0	524,780 (11.3)	6,580 (7.3)
1	479,650 (10.4)	10,615 (11.7)
2	1,033,230 (22.3)	18,430 (20.3)
3 or more	2,588,524 (56.0)	55,055 (60.7)

↓ Table 3. Comorbidities Among Patients With Cirrhosis, Stratified by the Presence of Pneumococcal Pneumonia

Comorbidities

Absence of pneumococcal pneumonia, n (%)

Presence of pneumococcal pneumonia, n (%)

P-value

n (%): number of patients in each group (percentage of patients).

Renal failure

1,234,195 (26.7)

25,270 (27.9)

< 0.001

Heart failure

1,121,440 (24.2)

31,185 (34.4)

< 0.001

Coronary artery disease

779,060 (16.8)

15,175 (16.7)

0.71

Chronic obstructive pulmonary disease

898,120 (19.4)

33,175 (36.6)

< 0.001

Alcohol use

2,354,424 (50.9)

43,575 (48.1)

< 0.001

Obesity

785,375 (17.0)

15,275 (16.8)

0.65

Smoking

2,159,469 (46.7)

38,890 (42.9)

< 0.001

Hyperlipidemia

1,203,495 (26.0)

21,145 (23.3)

< 0.001

Hypertension

1,466,824 (31.7)

22,635 (25.0)

< 0.001

Diabetes

1,641,819 (35.5)

37,870 (41.8)

< 0.001

Modified Charlson Comorbidity Index

< 0.001

524,780 (11.3)

6,580 (7.3)

479,650 (10.4)

10,615 (11.7)

1,033,230 (22.3)

18,430 (20.3)

3 or more

2,588,524 (56.0)

55,055 (60.7)

↓ **Table 4.** Clinical Outcomes and Resource Utilization Among Patients With Cirrhosis, Stratified by the Presence of Pneumococcal Pneumonia
	Absence of pneumococcal pneumonia	Presence of pneumococcal pneumonia	P-value
n (%): number of patients in each group (percentage of patients).
Outcomes, n (%)
In-hospital mortality	280,485 (6.1)	17,655 (19.5)	< 0.001
Shock	367,780 (8.0)	28,565 (31.5)	< 0.001
Intensive care unit admissions	351,715 (7.6)	37,105 (40.9)	< 0.001
Acute kidney injury	1,438,505 (31.1)	42,530 (46.9)	< 0.001
Non-home discharges	2,195,894 (47.5)	64,435 (71.1)	< 0.001
Resource utilization, mean ± SD
Mean length of stay (days)	6.14 ± 0.01	13.46 ± 0.12	< 0.001
Mean total hospitalization charges ($)	73,853.08 ± 503.28	195,248.1 ± 3,097.77	< 0.001

↓ Table 4. Clinical Outcomes and Resource Utilization Among Patients With Cirrhosis, Stratified by the Presence of Pneumococcal Pneumonia

Absence of pneumococcal pneumonia

Presence of pneumococcal pneumonia

P-value

n (%): number of patients in each group (percentage of patients).

Outcomes, n (%)

In-hospital mortality

280,485 (6.1)

17,655 (19.5)

< 0.001

Shock

367,780 (8.0)

28,565 (31.5)

< 0.001

Intensive care unit admissions

351,715 (7.6)

37,105 (40.9)

< 0.001

Acute kidney injury

1,438,505 (31.1)

42,530 (46.9)

< 0.001

Non-home discharges

2,195,894 (47.5)

64,435 (71.1)

< 0.001

Resource utilization, mean ± SD

Mean length of stay (days)

6.14 ± 0.01

13.46 ± 0.12

< 0.001

Mean total hospitalization charges ($)

73,853.08 ± 503.28

195,248.1 ± 3,097.77

< 0.001

↓ **Table 5.** Multivariate Logistic Regression Model Examining the Relationship Between Pneumococcal Pneumonia and Clinical Outcomes Among Patients With Cirrhosis
Outcomes	Adjusted odds ratio	95% Confidence interval	P-value
In-hospital mortality	2.95	2.84–3.09	< 0.001
Shock	4.75	4.58–4.93	< 0.001
Intensive care unit admissions	7.55	7.28–7.83	< 0.001
Acute kidney injury	1.85	1.79–1.91	< 0.001
Non-home discharges	2.29	2.21–2.38	< 0.001
Length of stay	6.61	6.38–6.83	< 0.001
Total hospitalization charges	112,230.50	106,802.3–117,658.7	< 0.001

↓ Table 5. Multivariate Logistic Regression Model Examining the Relationship Between Pneumococcal Pneumonia and Clinical Outcomes Among Patients With Cirrhosis

Outcomes

Adjusted odds ratio

95% Confidence interval

P-value

In-hospital mortality

2.95

2.84–3.09

< 0.001

Shock

4.75

4.58–4.93

< 0.001

Intensive care unit admissions

7.55

7.28–7.83

< 0.001

Acute kidney injury

1.85

1.79–1.91

< 0.001

Non-home discharges

2.29

2.21–2.38

< 0.001

Resource utilization

Adjusted odds coefficient

95% Confidence interval

P-value

Length of stay

6.61

6.38–6.83

< 0.001

Total hospitalization charges

112,230.50

106,802.3–117,658.7

< 0.001