VIDEO: Severe ACLF, worse survival in patients with liver disease and fungal infection
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CHICAGO — In a Healio video exclusive, Sarah Khan, MD, explains that patients with advanced liver disease and concurrent fungal infection had worse acute-on-chronic liver failure and higher mortality than those with bacterial infection.
With limited data on the epidemiology, baseline comorbidities and outcomes of fungal infection in acute-on-chronic liver failure, Khan and colleagues at the Cleveland Clinic used the prospective registry of patients admitted to the hospital’s medical liver intensive unit and identified 17 fungal and 183 bacterial culture-positive infections between August 2018 and September 2022.
According to results presented at Digestive Disease Week, patients with fungal infections were younger than those with bacterial infections (mean age, 51.5 years vs. 58.4 years), and had liver disease caused by cirrhosis, acute liver failure and Byler’s disease after transplant. Additionally, five patients with fungal infection had acute surgical illnesses including pancreatitis, cholecystitis and perforated viscus.
“We found that patients with fungal infection had higher degree of severe ACLF,” Khan said. “In fact, 90% of patients with fungal infection had severe ACLF, and patients with fungal infection had a significantly increased mortality compared to their bacterial counterparts.”
This was despite overall similarities in intensive care length of stay and transplant evaluation rates, she noted. None of the patients with fungal infection received a transplant and all died within 2 weeks.
“This raises the question to us of whether there is perhaps a threshold that could be developed or a point at which empiric antifungal coverage could be considered for these patients, particularly if they begin developing severe ACLF,” Khan said.
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Khan S, et al. Abstract 1011: Comparison of fungal vs. bacterial infections in acute-on-chronic liver failure: Cause or corollary for high mortality? Presented at: Digestive Disease Week; May 5-9, 2023; Chicago (hybrid meeting).
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