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Temporal Trends of Fungal Infections in Cirrhotic Patients: A Retrospective Cohort Study 2016-2020

Choday Silpa1, Talal Alomar1, Robert J Wong2

  • 1Creighton University School of Medicine-Phoenix Health Sciences Campus, Phoenix, AZ, United States.

Journal of Clinical and Experimental Hepatology
|January 24, 2025
PubMed
Abstract

Insights

Spontaneous fungal peritonitis (SFP) in cirrhosis patients leads to higher mortality, longer hospital stays, and increased costs compared to bacterial infections. Early diagnosis and antifungal treatment are crucial for better outcomes.

Area of Science:

  • Infectious Diseases
  • Hepatology
  • Critical Care Medicine

Background:

  • Cirrhosis impairs immune function, increasing susceptibility to infections.
  • Fungal infections in cirrhosis patients often present with delayed diagnosis and high mortality.
  • Prompt diagnosis and treatment of fungal infections are critical for this vulnerable population.

Purpose of the Study:

  • To analyze outcomes of cirrhotic patients readmitted with bacterial and fungal infections.
  • To compare in-hospital mortality, length of stay, and hospital resource utilization between spontaneous bacterial peritonitis (SBP) and spontaneous fungal peritonitis (SFP).

Main Methods:

  • Retrospective cohort study using the Nationwide Readmission Database (NRD) from 2016-2020.
  • Analysis of 393,195 index hospitalizations, focusing on 30-day and 90-day readmissions for SBP and SFP.
  • Hospital costs calculated using HCUP Cost-to-Charge Ratio files, adjusted for inflation.

Main Results:

  • SFP was associated with significantly increased mortality, longer length of stay (LOS), and higher hospital charges compared to SBP (P < 0.001).
  • Mean LOS for SFP ranged from 14.9 to 32.3 days, with Aspergilloses having the longest duration.
  • 30-day index admission charges were $51,739 for SFP versus $42,258 for SBP; readmission charges were $89,913 for SFP versus $64,266 for SBP.

Conclusions:

  • Spontaneous fungal peritonitis (SFP) presents worse outcomes than spontaneous bacterial peritonitis (SBP) in cirrhotic patients.
  • SFP should be considered in patients with cirrhosis who do not respond to antibiotic therapy.
  • Early recognition and antifungal treatment are vital for improving patient outcomes in SFP.
Keywords:
cirrhosiscirrhosis fungal trendscirrhosis readmissionsspontaneous bacterial peritonitisspontaneous fungal peritonitis

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