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Mycopathologia

, Volume 179, Issue 1–2, pp 63–71 | Cite as

Fungal “colonisation” is Associated with Increased Mortality in Medical Intensive Care Unit Patients with Liver Cirrhosis

  • Tobias Lahmer
  • Marlena Messer
  • Ulrich Mayr
  • Bernd Saugel
  • Sebastian Noe
  • Caroline Schultheiss
  • Philipp Thies
  • Christoph Spinner
  • Simon Nennstiel
  • Christiane Schwerdtfeger
  • Veit Phillip
  • Roland M. Schmid
  • Wolfgang Huber
Article

Abstract

Objectives

Patients with liver cirrhosis are at increased risk for fungal infections. However, distinction of fungal colonisation (FC) and invasive mycoses is difficult. Aim of this study was to analyse the impact of FC on mortality of cirrhotic ICU-patients.

Methods

Retrospective mortality analysis of a prospectively maintained database on 120 cirrhotic patients with and without FC. Comparison to 120 noncirrhotic controls matched for APACHE-II (24.9 ± 3.7 vs. 25.0 ± 2.6; p = 0.263).

Results

About 69/120 (58 %) of patients with cirrhosis had FC. These patients had significantly higher APACHE-II score and mortality compared to cirrhotic patients without FC (27 ± 3 vs. 23 ± 4, p < 0.001; 78 vs. 35 %, p < 0.001). In multivariate analysis, FC was independently (p = 0.047) associated to mortality. Mortality of noncirrhotic patients with FC (14/31; 45.2 %) was not different to noncirrhotic controls without FC [28/89 (31.2 %; p = 0.168)]. Similarly, in multivariate analysis of noncirrhotics, APACHE-II (p < 0.001), but not FC, was independently associated to mortality. Multiple regression analysis of all 240 cirrhotic and noncirrhotic patients demonstrated that APACHE-II (p < 0.001), cirrhosis (p = 0.001) and FC (p = 0.049) were independently associated with mortality.

Conclusion

Fungal “colonisation” is independently associated to mortality in cirrhotic ICU-patients. Early antimycotic therapy should be considered in critically ill cirrhotic patients with FC.

Keywords

Fungal colonisation Liver cirrhosis Critical ill patients Invasive mycoses 

Notes

Conflict of interest

None of the authors has any potential financial conflict of interest related to this manuscript.

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Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Tobias Lahmer
    • 1
  • Marlena Messer
    • 1
  • Ulrich Mayr
    • 1
  • Bernd Saugel
    • 1
  • Sebastian Noe
    • 1
  • Caroline Schultheiss
    • 1
  • Philipp Thies
    • 1
  • Christoph Spinner
    • 1
  • Simon Nennstiel
    • 1
  • Christiane Schwerdtfeger
    • 1
  • Veit Phillip
    • 1
  • Roland M. Schmid
    • 1
  • Wolfgang Huber
    • 1
  1. 1.II. Medizinische Klinik und PoliklinikKlinikum rechts der Isar der Technischen Universität MünchenMunichGermany

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