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Burden of Invasive Fungal Diseases in Patients With Alcohol-Related Hepatitis and Organ Failure
Charlotte Mouliade1,2, Lucia Parlati1,2, Stylianos Tzedakis2,3
1AP-HP.Centre, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et Spécialités Médico-Chirurgicales, Service Des Maladies du Foie, Paris, France.
Background:
The burden of invasive fungal diseases (IFDs) in patients with complicated alcoholic hepatitis (CAH)-defined by ≥ 2 hepatic (ascites, jaundice, liver failure, encephalopathy) or extrahepatic (coagulopathy, shock, kidney or respiratory failure) dysfunctions within 30 days-remains poorly characterised.
Aims:
To assess the burden of IFDs in CAH and compare it with bacterial pneumonia (BP).
Methods:
We conducted a retrospective nationwide cohort study of adult CAH patients in France (2012-2021). The primary exposure were IFDs. The primary outcome was 3-month mortality or liver transplantation. Associations were assessed with adjusted odds ratios (aORs) in complete-case and propensity score-matched cohorts. A 6-week landmark analysis and time-dependent Cox models were used to evaluate time-varying effects.
Results:
Among 11,434 CAH patients (median age 55 years; 72% male), 2.2% and 15% developed IFDs and BP, respectively. Three-month survival was 17.5% (95% CI: 13.0-23.0) in IFDs, 46.8% (44.3-49.3) in BP and 60.0% (59.4-61.4) in those without either (p < 0.001). IFDs occurred in 44.3% of patients with BP, and BP increased IFD risk (aOR 2.93, 95% CI: 2.23-3.84). In matched analyses, IFDs were associated with a fourfold increase in mortality (aOR 4.58, 95% CI: 3.02-7.20), while BP showed a lower association (aOR 1.23, 95% CI: 1.06-1.43). IFDs were strong time-dependent predictors of death.
Conclusions:
IFDs affected 1 in 50 CAH patients and carried a disproportionate mortality risk, compared with BP. These findings support the implementation of targeted screening and early antifungal strategies in CAH management, as for BP.
Insights
Invasive fungal diseases (IFDs) affect 1 in 50 patients with complicated alcoholic hepatitis (CAH), significantly increasing mortality risk compared to bacterial pneumonia (BP). Early screening and antifungal treatments are recommended for CAH management.
Area of Science:
- Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Invasive fungal diseases (IFDs) burden in complicated alcoholic hepatitis (CAH) is not well-characterized.
- CAH is defined by multiple organ dysfunctions within 30 days.
- Understanding IFD impact is crucial for patient outcomes.
Purpose of the Study:
- To determine the incidence and impact of IFDs in CAH patients.
- To compare the outcomes of IFDs with bacterial pneumonia (BP) in CAH.
- To inform clinical management strategies for CAH.
Main Methods:
- Retrospective nationwide cohort study in France (2012-2021).
- Inclusion of adult CAH patients.
- Analysis of IFDs and BP as primary exposures, with 3-month mortality or liver transplantation as primary outcomes.
- Use of adjusted odds ratios and propensity score matching for association analysis.
Main Results:
- 2.2% of 11,434 CAH patients developed IFDs; 15% developed BP.
- 3-month survival was significantly lower in IFDs (17.5%) compared to BP (46.8%) and no infection (60.0%).
- IFDs were associated with a fourfold increase in mortality (aOR 4.58) in matched analyses, a higher risk than BP (aOR 1.23).
Conclusions:
- IFDs represent a significant threat in CAH, affecting 1 in 50 patients.
- IFDs carry a disproportionately high mortality risk compared to BP in CAH.
- Findings support targeted screening and early antifungal interventions for CAH patients, similar to BP management.
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