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Spontaneous fungal peritonitis: a devastating complication of cirrhosis
Derek N Bremmer1, Jeffrey M Garavaglia1, Ryan K Shields2
1Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, PA, USA.
Abstract:
Spontaneous bacterial peritonitis is a well-known complication of cirrhosis; however, spontaneous fungal peritonitis (SFP) is less well-recognised and described. Our objective was to determine the clinical characteristics, treatment outcomes and factors associated with death among patients with SFP. We performed a retrospective cohort study using the primary outcome of all-cause mortality at 28 days. Twenty-five patients were included; Candida species were the causative pathogen in all cases. At the onset of SFP, patients were critically ill, median APACHE II and MELD scores were 22 and 30.3, respectively. The 28-day mortality rate was 56%; six patients died prior to culture positivity. Among the remaining patients, there were no differences in rates of death by treatment regimen (P = 0.55). APACHE II score at the onset of SFP was an independent predictor of death (OR = 1.46, 95% CI = 1.02-2.08, P = 0.04). In conclusion, SFP develops among critically ill patients with cirrhosis and is associated with high rates of death. Directed antifungal therapy did not improve patient outcomes. Future studies assessing the benefit of early or pre-emptive antifungal therapy are warranted.
Insights
Spontaneous fungal peritonitis (SFP) in cirrhosis patients is a serious condition with a high mortality rate. Early diagnosis and treatment are crucial, but current therapies show limited impact on survival.
Area of Science:
- Hepatology and Infectious Diseases
- Critical Care Medicine
Background:
- Spontaneous bacterial peritonitis is a known complication of cirrhosis.
- Spontaneous fungal peritonitis (SFP) is less recognized but occurs in critically ill cirrhosis patients.
- Understanding SFP's characteristics and outcomes is vital for patient management.
Purpose of the Study:
- To determine clinical characteristics of spontaneous fungal peritonitis (SFP).
- To evaluate treatment outcomes for SFP.
- To identify factors associated with mortality in SFP patients.
Main Methods:
- Retrospective cohort study.
- Included 25 patients with SFP.
- Primary outcome: 28-day all-cause mortality; analyzed APACHE II and MELD scores.
Main Results:
- Candida species caused all SFP cases.
- Patients were critically ill with high APACHE II (22) and MELD (30.3) scores.
- 28-day mortality was 56%; APACHE II score independently predicted death (OR=1.46, P=0.04).
Conclusions:
- SFP is associated with high mortality in critically ill cirrhosis patients.
- Directed antifungal therapy did not significantly improve outcomes.
- Further research on early or pre-emptive antifungal strategies is warranted.
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