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

Nipun Verma1, Shreya Singh2, Akash Roy1

  • 1Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Mycoses
|June 17, 2022
PubMed
Abstract

Insights

Fungal infections (FIs) in cirrhosis patients lead to significantly higher mortality, especially with acute-on-chronic liver failure (ACLF) or ICU admission. This highlights an urgent need for better fungal diagnostics and treatments in this vulnerable group.

Area of Science:

  • Medical Mycology
  • Hepatology
  • Critical Care Medicine

Background:

  • Cirrhosis patients face increased susceptibility to infections.
  • Fungal infections (FIs) represent a significant, yet often underestimated, threat in this population.
  • Understanding the outcomes of FIs in cirrhosis is crucial for improving patient management.

Purpose of the Study:

  • To quantify the mortality associated with fungal infections in cirrhosis patients.
  • To identify factors contributing to poor outcomes in these patients.
  • To compare the prognosis of fungal infections with other infections in cirrhosis.

Main Methods:

  • A systematic literature search was conducted across major databases (PubMed, Embase, WOS).
  • Random-effects meta-analysis was used to pool mortality estimates and relative risks (RR).
  • Subgroup analysis, meta-regression, and machine learning (ML) were employed to explore heterogeneity and identify outliers.

Main Results:

  • The pooled mortality for fungal infections in cirrhosis was 64.1%, 2.1 times higher than controls.
  • Higher CTP and MELD scores, organ failures, and longer hospital stays were associated with FIs.
  • Mortality was highest in patients with acute-on-chronic liver failure (ACLF) and ICU admission, and for pulmonary FIs.

Conclusions:

  • Fungal infections portend a worse prognosis than bacterial infections in cirrhosis patients.
  • There is a critical unmet need for improved diagnostics and therapeutics for FIs in this population.
  • ACLF and ICU admission should be incorporated into criteria for defining invasive fungal infections (IFIs).
Keywords:
ACLFantifungalscirrhosisinvasive fungal infectionsmachine learningmortality

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