Publication

Abstract : Objectives We evaluated the magnitude and factors contributing to poor outcomes among cirrhosis patients with fungal infections (FIs). Methods We searched PubMed, Embase, Ovid, and WOS and included articles reporting mortality in cirrhosis with FIs. We pooled the point and relative-risk (RR) estimates of mortality on random-effects meta-analysis and explored their heterogeneity (I2) on subgroups, meta-regression, and machine learning (ML). We assessed the study quality through New-Castle-Ottawa-Scale and estimate-asymmetry through Eggers regression (CRD42019142782). Results Of 4345, 34 studies (2134 patients) were included (good/fair/poor quality: 12/21/1). Pooled mortality of FIs was 64.1% (95%CI: 55.4-72.0, 12: 87%, P <.01), which was 2.1 times higher than controls (95%CI: 1.8-2.5, 12:89%, P <.01). Higher CTP (MD: +0.52, 95%CI: 0.27-0.77), MELD (MD: +2.75, 95% CI: 1.21-4.28), organ failures, and increased hospital stay (30 vs. 19 days) was reported among cases with FIs. Patients with ACLF (76.6%, RR: 2.3), and ICU-admission (70.4%, RR: 1.6) had the highest mortality. The risk was maximum for pulmonary-FIs (79.4%, RR: 1.8), followed by peritoneal-FIs (68.3%, RR: 1.7) and fungemia (55%, RR: 1.7). The mortality was higher in FIs than bacterial (RR: 1.7) or no-infections (RR: 2.9). Estimate-asymmetry was evident (P <.05). Up to 8 clusters and 5 outlier studies were identified on ML, and the estimate-heterogeneity was eliminated on excluding such studies. Conclusions A substantially worse prognosis, poorer than bacterial infections in cirrhosis patients with FIs indicates an unmet need for improving fungal diagnostics and therapeutics in this population. ACLF and ICU admission should be included in host criteria for defining IFIs.