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Meta-Analysis
. 2022 Mar;65(3):266-284.
doi: 10.1111/myc.13387. Epub 2021 Dec 5.

Global epidemiological burden of fungal infections in cirrhosis patients: A systematic review with meta-analysis

Nipun Verma  1 , Shreya Singh  2 , Manvi Singh  3 , Anil Chauhan  3 , Pranita Pradhan  3 , Nishant Jaiswal  3 , Arunaloke Chakrabarti  2 , Meenu Singh  3
Affiliations
Meta-Analysis

Global epidemiological burden of fungal infections in cirrhosis patients: A systematic review with meta-analysis

Nipun Verma et al. Mycoses. 2022 Mar.

Abstract

Background and aims: Fungal infections (FIs) have serious implications, yet understated in cirrhosis. Therefore, we reviewed the epidemiology and trends of FIs among cirrhotics.

Methods: Four electronic databases were searched for full-text articles describing prevalence of FIs in cirrhosis. Studies from post-transplant, malignancy and classical-immuno-deficiency patients were excluded. A random-effects meta-analysis was done to pool estimates of FIs (overall, and by type and infection-site), and their variation(I2 ) was explored on moderator-analysis and meta-regression. Risk of bias and asymmetry in estimates was assessed by a checklist and Egger's regression, respectively.(CRD42019142782).

Results: Thirty-four low-risk and four moderate-risk studies (31 984 cirrhotics) were included. Pooled estimates of overall FIs (17 studies), invasive fungal infections (IFIs; 17 studies), invasive candidiasis (23 studies) and invasive aspergillosis (16 studies) in cirrhosis were 10.2%(6.0-16.9), 9.5%(5.4-16.2), 4.0%(2.0-8.0) and 2.8%(1.5-5.3), respectively (I2 > 90%;each). Site of FIs in decreasing order of pooled prevalence was pulmonary, urinary tract, bloodstream, peritoneal, oesophageal and cerebral. Geographic differences in these estimates were remarkable, with highest burden of overall FIs from Belgium, the United States and India. Non-albicans-Candida and Aspergillus infections have increased over the last decade in cirrhosis. Intensive-care-unit (ICU)-admitted and acute-on-chronic liver failure (ACLF) patients had the highest prevalence of IFIs. MELD score(cases), bias score and sample size across studies were the predictors of variance in overall FI estimates. Diabetes, steroid and broad-spectrum antibiotic-exposure, and multiple organ failures were the common predispositions reported in patients with FIs.

Conclusions: FIs impose a substantial burden in cirrhosis. ACLF and ICU admission should be considered as a host factor for defining IFIs. Epidemiology of FIs can guide interpretation of biomarkers and antifungal treatment in cirrhosis.

Keywords: ACLF; invasive fungal infections; liver failure; mortality; mycoses.

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References

REFERENCES

    1. Bongomin F, Gago S, Oladele RO, Denning DW. Global and Multi-National Prevalence of Fungal Diseases-Estimate Precision. J Fungi (Basel). 2017;3(4):57.
    1. GBD 2017 Cirrhosis Collaborators. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2020;5(3):245-266.
    1. Jalan R, Fernandez J, Wiest R, et al. Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. J Hepatol. 2014;60(6):1310-1324.
    1. Tariq T, Irfan FB, Farishta M, Dykstra B, Sieloff EM, Desai AP. Spontaneous fungal peritonitis: Micro-organisms, management, and mortality in liver cirrhosis-A systematic review. World J Hepatol. 2019;11(7):596-606.
    1. Fiore M, Chiodini P, Pota V, et al. risk of spontaneous fungal peritonitis in hospitalized cirrhotic patients with ascites: a systematic review of observational studies and meta-analysis. Minerva Anestesiol. 2017;83(12):1309-1316.

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