Fungal infections in patients with chronic liver disease: mortality and associated risk factors

Abstract

Background: Patients with chronic liver disease are immunocompromised and prone to different opportunistic infections. Fungal infections in patients admitted with liver cirrhosis are not rare and they may increase mortality and morbidity of these patients. Aims of the study is to determine the mortality and its risk factors associated with fungal infections in patients with chronic liver disease.Methods: In this retrospective study, patients admitted with chronic liver disease during the last four years on this hospital were studied for diagnosed fungal infections. A matched control group of cirrhosis patients with a ratio of 1:2 admitted without fungal infections was also studied and mortality was compared between the two groups.Results: Seventy admitted patients of liver cirrhosis with microbial and histopathological evidence of fungal infection were found while 140 patients of the control group had no evidence of fungal infection. Hepatitis C virus infection was the major cause of cirrhosis (65%) and most of the patients were in child class C(63%). Urinary tract infection, esophageal candidiasis, and mucormycosis were major fungal infections. Mortality was much higher in the fungal infections group (34.3%) as compared to the non-infectious group (16%). On multivariate analysis, high WBCs count, hypo-albuminemia and high creatinine levels were the worst factors affecting mortality.Conclusions: Fungal infections are a significant cause of morbidity and mortality in patients with decompensated cirrhosis. Advanced cirrhosis, renal insufficiency, and leucocytosis are independent predictors of fatal outcome in these patients.

Fungal urinary tract infection among chronic liver disease patients with hepatic encephalopathy and its treatment outcomes

“…Bassetti et al reported that, in 169 patients with fungal infection, 46% of patients were infected with non‐candida species, and 35% of mortality was linked to candida infection and absent or inadequate antifungal treatment 22 . Rasool et al 23 reported renal insufficiency as one of the predictors of mortality in fungal infections in CLD patients, and similar findings were observed in our study.…”

Cirrhosis and fungal infections‐a cocktail for catastrophe: A systematic review and meta‐analysis with machine learning

“…Population was reported mainly into three categories, that is ICUadmitted cirrhosis (nine studies), 35,[44][45][46][47][48][49][50]57 hospitalised-ACLF (eight studies) 12,13,[51][52][53][54][55][56] or all-hospitalised cirrhosis with admission area not specified (17 studies). [26][27][28][29][30][31][32][33][34][36][37][38][39][40][41][42][43] Eighteen, eight and eight studies examined proven, 26,28,[31][32][33][35][36][37]39,[41][42][43]45,46,48,50,…”

“…[26][27][28][29][30][31][32][33][34][36][37][38][39][40][41][42][43] Eighteen, eight and eight studies examined proven, 26,28,[31][32][33][35][36][37]39,[41][42][43]45,46,48,50,51,57 probable 29,30,34,38,47,49,55,56 and proven+probable FIs, 12,13,27,40,44,[52][53][54] respectively. Studies emanated from Europe (15 studies) , 12,…”

“…Studies emanated from Europe (15 studies) , 12,26,29,31,35,36,41,[44][45][46][47][48][49]51,54 Asia (10 studies), 13,27,34,38,39,43,52,53,55,56 North America (seven studies) studies). 28,50 Most of the included studies (26 studies) were retrospective in design 12,13,27,30,31,[33][34][35][36][37][38][39][41][42][43][44][45][46][47]49,[51][52][53][55][56]…”

“…26,28,29,32,40,48,50,54 Most of the studies were conducted in last decade (32 studies). 12,13,[26][27][28][29][31][32][33][34][36][37][38]40,41,[44][45][46][47][49][50][51][54][55][56][57] Patients were typically of male-gender (71.9% in cases, 70.3% in controls) with a median age (years) of 55. and CTP (11.3, range: 9.2-12.9, 10 studies) of patients with FIs was higher than that of patients without FIs (21.0, range: 15.0-28.0) and (10.3, range: 9.0-11.9). Higher number of organ failures and length of stay were reported among patients with FIs (30 days; range: than those without FIs (19 days; range: 10-24).…”