{
  "abstract": "IntroductionAcute lower respiratory tract disease (aLRTD) is a leading cause of hospitalisation and death, particularly in older adults and adults with comorbidities, with acute lower respiratory tract infection (aLRTI; pneumonia and non-pneumonic LRTI) being a major component. Non-pulmonary complications and functional decline after aLRTI are recognised, but their pathogen-specific burden is poorly described. We aimed to quantify renal, hepatic, thromboembolic and functional complications, and mortality, after aLRTI hospitalisation, by clinical phenotype and pathogen.\n\nMethodsWe conducted a cohort study of adults ([≥]18 years) admitted with aLRTD to two hospitals in Bristol, UK (01 August 2022-31 July 2024). aLRTD was classified as pneumonia, non-pneumonic LRTI (NP-LRTI) or no diagnosis of aLRTI. Pathogens were identified from standard-of-care and research microbiology. Outcomes were acute kidney injury (AKI), acute liver dysfunction, venous thromboembolism (VTE), in-hospital falls, reduced mobility at discharge, increased care requirements, and 30-day and 1-year mortality. Analyses were descriptive.\n\nResultsAmong 246,797 adult admissions, 21,456 aLRTD hospitalisations were included: 10,239 (47.7%) pneumonia, 7,742 (36.1%) NP-LRTI and 3,475 (16.2%) with no evidence of aLRTI. Of 19,152 tested aLRTD admissions, 8,503 (44.4%) had a positive microbiological/virological test, yielding 9,204 pathogen detections; 1,194 (6.2%) had co-infections, and SARS-CoV-2 was most frequent, with influenza the second most common in pneumonia and NP-LRTI. Pneumonia had greater severity than NP-LRTI and no diagnosis of aLRTI (median length of stay 6 vs 4 vs 4 days; ICU admission 3.4% vs 0.7% vs 0.5%, respectively). Overall, 22.2% developed AKI, 6.1% acute liver dysfunction, 0.6% DVT and 2.4% PE; 1.8% had a fall, 11.5% reduced mobility, and 16.6% required increased care at discharge. 30-day and 1-year mortality were highest for pneumonia (14.0% and 32.0%, respectively). Pathogen-specific analyses showed longer stays and higher complications and mortality rates for SARS-CoV-2 and Streptococcus pneumoniae, and shorter stays with lower complication and mortality rates for influenza and Haemophilus influenzae.\n\nConclusionsNon-cardiovascular complications and functional decline after aLRTI were common, particularly in pneumonic and SARS-CoV-2 or pneumococcal disease. These findings support routine surveillance for renal, hepatic, thromboembolic events, early mobilisation and rehabilitation, and consideration of multi-system outcomes when evaluating public health and economic value of vaccines and therapies.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Engineering Mathematics, University of Bristol, UK."
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 24,
  "authors": [
    {
      "name": "A. Chatzilena"
    },
    {
      "name": "C. Hyams"
    },
    {
      "name": "R. Challen"
    },
    {
      "name": "M. Lahuerta"
    },
    {
      "name": "S. McGuinness"
    },
    {
      "name": "M. Clout"
    },
    {
      "name": "E. Begier"
    },
    {
      "name": "J. King"
    },
    {
      "name": "B. Morales-Aza"
    },
    {
      "name": "K. Duale"
    },
    {
      "name": "A. Rodriguez Pereira"
    },
    {
      "name": "W. Healy"
    },
    {
      "name": "J. Southern"
    },
    {
      "name": "P. Wells"
    },
    {
      "name": "K. Lihou"
    },
    {
      "name": "C. Grimes"
    },
    {
      "name": "J. A. Campling"
    },
    {
      "name": "N. Maskell"
    },
    {
      "name": "J. Oliver"
    },
    {
      "name": "A. Vyse"
    },
    {
      "name": "B. Gessner"
    },
    {
      "name": "A. Finn"
    },
    {
      "affs": [
        0
      ],
      "name": "L. Danon"
    },
    {
      "name": "The AvonCAP Research Group"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0g8p6e0pnbdzy.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.08.28.26361617",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.08.28.26361617v1.full",
  "id": "0g8p6e0pnbdzy",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.08.28.26361617v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "respiratory medicine"
    ],
    [
      "openalex",
      "2713|Pneumonia and Respiratory Infections"
    ]
  ],
  "openalex": "W7206156888",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.08.28.26361617v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-08-28",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/0g8p6e0pnbdzy.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:34Z",
      "native_id": "10.64898/2026.08.28.26361617",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.08.28.26361617v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Pneumonia and Respiratory Infections",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Acute Renal, Hepatic, Thromboembolic and Functional Complications after Community-Acquired Acute Lower Respiratory Tract Infection: A Prospective Cohort Study in Bristol, UK, 2022-2024",
  "title_text": "Acute Renal, Hepatic, Thromboembolic and Functional Complications after Community-Acquired Acute Lower Respiratory Tract Infection: A Prospective Cohort Study in Bristol, UK, 2022-2024",
  "type": "preprint",
  "updated_at": "2026-10-30T12:17:34Z",
  "url": "https://research.draconitic.com/paper/0g8p6e0pnbdzy",
  "venue": "medRxiv",
  "versions": []
}