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Pneumocystis Pneumonia in Cirrhosis: An Underrecognized Fungal Infection in a Vulnerable Host

Aaron M Pulsipher1, Michele Barnhill2, Holenarasipur R Vikram3

  • 1Department of Critical Care, Mayo Clinic, Phoenix, AZ 85054, USA.

Journal of Fungi (Basel, Switzerland)
|September 23, 2025
PubMed

Insights

Patients with decompensated cirrhosis face a significantly higher mortality risk from Pneumocystis pneumonia (PCP). This condition alone is an underrecognized risk factor for PCP, necessitating further research into prevention strategies.

Area of Science:

  • Infectious Diseases
  • Hepatology
  • Critical Care Medicine

Background:

  • Pneumocystis pneumonia (PCP) is a severe opportunistic infection primarily affecting immunocompromised individuals.
  • Decompensated cirrhosis causes cirrhosis-associated immune dysfunction (CAID), impairing cellular immunity and increasing susceptibility to infections like PCP.

Purpose of the Study:

  • To investigate the association between decompensated cirrhosis and the outcomes of Pneumocystis pneumonia.
  • To determine if decompensated cirrhosis is an independent risk factor for PCP-related mortality and morbidity.

Main Methods:

  • Retrospective review of 727 patients diagnosed with proven or probable PCP between 2017 and 2025.
  • Stratification of 33 patients with decompensated cirrhosis into 'Cirrhosis Only' and 'Cirrhosis with Additional Immunocompromising Conditions' groups.
  • Comparison of mortality, intensive care unit (ICU) admission rates, and need for renal replacement therapy between patients with and without cirrhosis.

Main Results:

  • Patients with decompensated cirrhosis had a significantly higher overall mortality (48%) and 90-day mortality (57.6%) compared to those without cirrhosis.
  • Cirrhosis patients exhibited a fourfold increased risk of mortality (OR: 4.08), higher ICU admission rates (87% vs. 42%), and a greater need for renal replacement therapy (54.6% vs. 7.5%).
  • Decompensated cirrhosis was associated with substantially worse outcomes in patients with PCP.

Conclusions:

  • Decompensated cirrhosis may be a sufficient and underrecognized risk factor for PCP, carrying a high mortality burden.
  • The findings highlight the vulnerability of patients with cirrhosis to PCP and the severity of this infection in this population.
  • Further research is warranted to assess PCP incidence, define risks, and explore prophylactic strategies for individuals with decompensated cirrhosis.
Keywords:
antifungal prophylaxischronic liver failurecirrhosis-associated immune dysfunctionimmunocompromised hostopportunistic infections

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