Invasive Fungal Infections in Decompensated Cirrhosis: A Clinical Case Series and Its Prognostic Implications

Systemic fungal infections are an under-recognized cause of morbidity and mortality in patients with decompensated liver cirrhosis. Our goal was to describe the clinical features, microbiological findings, and outcomes of invasive fungal infections in this population in the context of a liver transplant center.

We conducted a retrospective observational study of 16 adult patients with decompensated cirrhosis and culture-proven invasive fungal infections diagnosed between 2013 and 2024. Data were collected from electronic medical records and microbiology databases. Fungal pathogens were isolated from blood or ascitic fluid cultures. We analyzed demographics, cirrhosis etiology, antifungal treatment, and outcomes.

The mean age was 41 years, and 50% of patients were female. All patients had decompensated cirrhosis and a mean model for end-stage liver disease-sodium score of 25.7. Half of them met criteria for acute-on-chronic liver failure at diagnosis. The most frequent isolates were Candida albicans (37.5%) and Cryptococcus neoformans (37.5%). Ascites was present in 87.5% of patients; and 68.8% had received antibiotics, while 31.2% had received corticosteroids, within 30 days prior to diagnosis. In-hospital mortality was 62.5%, with a median survival of 11 days.

Invasive fungal infections in decompensated cirrhosis are associated with high short-term mortality and often occur in patients who have been exposed to antibiotics or corticosteroids. Awareness of this complication and prompt initiation of antifungal treatment may improve outcomes. Multicenter studies are needed to define risk factors and optimize diagnostic and therapeutic strategies.