Acute Renal, Hepatic, Thromboembolic and Functional Complications after Community-Acquired Acute Lower Respiratory Tract Infection: A Prospective Cohort Study in Bristol, UK, 2022-2024
- 1Department of Engineering Mathematics, University of Bristol, UK.
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.
MethodsWe 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.
ResultsAmong 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.
ConclusionsNon-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.
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BibTeX
@misc{chatzilena2026acute,
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}},
author = {A. Chatzilena and C. Hyams and R. Challen and M. Lahuerta and S. McGuinness and M. Clout and E. Begier and J. King and B. Morales-Aza and K. Duale and A. Rodriguez Pereira and W. Healy and J. Southern and P. Wells and K. Lihou and C. Grimes and J. A. Campling and N. Maskell and J. Oliver and A. Vyse and B. Gessner and A. Finn and L. Danon and The AvonCAP Research Group},
howpublished = {medRxiv},
year = {2026},
month = aug,
doi = {10.64898/2026.08.28.26361617},
url = {https://www.medrxiv.org/content/10.64898/2026.08.28.26361617v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Acute Renal, Hepatic, Thromboembolic and Functional Complications after Community-Acquired Acute Lower Respiratory Tract Infection: A Prospective Cohort Study in Bristol, UK, 2022-2024
AU - A. Chatzilena
AU - C. Hyams
AU - R. Challen
AU - M. Lahuerta
AU - S. McGuinness
AU - M. Clout
AU - E. Begier
AU - J. King
AU - B. Morales-Aza
AU - K. Duale
AU - A. Rodriguez Pereira
AU - W. Healy
AU - J. Southern
AU - P. Wells
AU - K. Lihou
AU - C. Grimes
AU - J. A. Campling
AU - N. Maskell
AU - J. Oliver
AU - A. Vyse
AU - B. Gessner
AU - A. Finn
AU - L. Danon
AU - The AvonCAP Research Group
PY - 2026
DA - 2026/08/28
PB - medRxiv
DO - 10.64898/2026.08.28.26361617
UR - https://www.medrxiv.org/content/10.64898/2026.08.28.26361617v1
AB - 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. MethodsWe 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. ResultsAmong 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. ConclusionsNon-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.
ER -