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Clinical characteristics and predictors of mortality in cirrhotic patients with candidemia and intra-abdominal candidiasis: a multicenter study

Abstract

Purpose

The aim of the study was to describe the characteristics of cirrhotic patients with candidemia and intra-abdominal candidiasis (IAC) and to evaluate the risk factors associated with 30-day mortality.

Methods

A multicenter multinational retrospective study including all consecutive episodes of candidemia and IAC in adult patients with liver cirrhosis in 14 European hospitals during the period 2011–2013 was performed.

Results

A total of 241 episodes (169 candidemia, 72 IAC) were included. Most Candida infections were acquired in hospital (208, 86.3%), mainly in the intensive care unit (ICU) (121, 50.2%). At clinical presentation, fever was seen in 60.6% of episodes (146/241) and septic shock in 34.9% (84/241). C. albicans was the most common species (found in 131 episodes, 54.4%), followed by C. glabrata (35, 14.5%) and C. parapsilosis (34, 14.1%). Overall, the 30-day mortality was 35.3%. Multivariable analysis identified candidemia (OR 2.2, 95% CI 1.2–4.5) and septic shock (OR 3.2, 95% CI 1.7–6) as independent factors associated with 30-day mortality. Adequate antifungal treatment (OR 0.4, 95% CI 0.3–0.9) was associated with survival benefit.

Conclusions

A shift towards increasing prevalence of C. glabrata and C. parapsilosis species in patients with liver disease was documented. Candidemia and IAC were associated with significant mortality in cirrhotic patients. Thirty-day mortality was associated with candidemia and severe clinical presentation, whereas adequate antifungal treatment improved the prognosis.

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Abbreviations

CA:

Community associated

CAID:

Cirrhosis-associated immune dysfunction

CVC:

Central venous catheter

IAC:

Intra-abdominal candidiasis

ICU:

Intensive care unit

IFI:

Invasive fungal infections

MELD:

Model for End-Stage Liver Disease

OR:

Odds ratio

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Correspondence to Matteo Bassetti.

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None of the authors has a financial relationship with a commercial entity with an interest in the subject of the presented manuscript or any other conflicts of interest to disclose.

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Additional information

Take-home message: Cirrhotic patients with invasive Candida infections are highly susceptible to septic shock. Thirty-day mortality in cirrhotic patients is associated with advanced liver disease, candidemia, and severe disease at clinical presentation, whereas adequate antifungal treatment improves the prognosis.

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Bassetti, M., Peghin, M., Carnelutti, A. et al. Clinical characteristics and predictors of mortality in cirrhotic patients with candidemia and intra-abdominal candidiasis: a multicenter study. Intensive Care Med 43, 509–518 (2017). https://doi.org/10.1007/s00134-017-4717-0

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Keywords

  • Candida
  • Invasive candidiasis
  • Candidemia
  • Intra-abdominal candidiasis
  • Cirrhosis