Prevalence, Predictors, and Outcomes of Esophageal Candidiasis in Cirrhosis: An Observational Study With Systematic Review and Meta-Analysis (CANDID-VIEW)

Verma, Nipun; Mishra, Saurabh; De, Arka; Premkumar, Madhumita; Taneja, Sunil; Duseja, Ajay; Singh, Virendra

doi:10.1016/j.jceh.2021.03.005

Cited by 7 publications

(7 citation statements)

References 39 publications

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“…The present study showed that the prevalence of OC was 3.3% among patients with liver cirrhosis. This is similar to the prevalence of 3.6% reported by another study from North India by Verma et al (2020) [12]. However, the present study reported a lower prevalence of OC compared to [13,14].…”

Section: N Discussionsupporting

confidence: 92%

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Predictors for oesophageal candidiasis in patients with liver cirrhosis

et al. 2023

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Background and aim: Oesophageal candidiasis (OC) is one of the most common infections among patients with liver cirrhosis. The present study evaluates the potential predictors for OC among liver cirrhosis patients. Methodology: This retrospective study was conducted in the tertiary care centre of coastal Karnataka from January 2016 to April 2022. Patients aged 18 and above with a confirmed diagnosis of liver cirrhosis were selected. Patients were equally divided into two groups, i.e., case and control, based on the presence and absence of OC. Results: A total of 1513 patients with cirrhosis underwent upper gastrointestinal endoscopy. Of these, 50 (3.3%) were diagnosed with OC and taken into case group. An equal number of patients were selected in control group and matched for gender, age and etiology. Most participants were male (94%), with a mean age of 48.46±11.82 years. A lower serum creatinine value was noted among patients with OC. Binary logistic regression identified serum creatinine as an independent predictor for OC (OR: 7.65, 95% CI: 2.012-29.08; p-value: 0.003). The receiver operating characteristic curve for serum creatinine showed the highest significance with a cut-off of <0.86 mg/dL (AUC: 0.722). Conclusion: Serum creatinine is the independent predictor for OC among liver cirrhosis patients. The possible mechanism is that cirrhosis is a catabolic state in which muscle protein breakdown exceeds synthesis, resulting in decreased muscle mass and low creatinine levels. However, more prospective studies are required to evaluate the role of sarcopenia with OC among liver cirrhosis patients.

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Section: N Discussionsupporting

confidence: 92%

“…However, the present study reported a lower prevalence of OC compared to [13,14]. The present study reported a higher prevalence of PHG among patients with OC than those without (p<0.008); this is similar to the findings of Verma et al (2020) [12].…”

Section: N Discussionsupporting

confidence: 91%

Predictors for oesophageal candidiasis in patients with liver cirrhosis

et al. 2023

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“…ACLF patients have been associated with higher mortality in IA 7 , IC and EC patients. 69 Therefore, we recommend that ACLF and ICU admission may be included as host criteria for diagnosing IFIs in general.…”

Section: Discussionmentioning

confidence: 99%

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

Verma

Singh

Chauhan

et al. 2021

Mycoses

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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 classicalimmuno-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(I 2 ) 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 (I 2 > 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-careunit (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 broadspectrum 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.

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“…3,4 Although bacterial infection is a well-known complication, an increasing prevalence of fungal infections (FIs) 5 and associated morbidity and mortality in cirrhosis patients is alarming. [6][7][8][9] FIs are associated with increased morbidity due to acute kidney injury, hepatic encephalopathy, gastrointestinal bleeding and shock. 6 FIs can precipitate acute-on-chronic liver failure (ACLF) multi-organ failures and often leads to delisting from liver transplantation.…”

Section: Introductionmentioning

confidence: 99%

“…There is an inarguably huge burden and poor outcomes for infections in cirrhosis patients 3,4 . Although bacterial infection is a well‐known complication, an increasing prevalence of fungal infections (FIs) 5 and associated morbidity and mortality in cirrhosis patients is alarming 6–9 . FIs are associated with increased morbidity due to acute kidney injury, hepatic encephalopathy, gastrointestinal bleeding and shock 6 .…”

Section: Introductionmentioning

confidence: 99%

Cirrhosis and fungal infections‐a cocktail for catastrophe: A systematic review and meta‐analysis with machine learning

Verma

Roy

Valsan

et al. 2022

Mycoses

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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 (I 2) 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, I 2: 87%, p < .01), which was 2.1 times higher than controls (95% CI: 1.8–2.5, I 2:89%, 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) were 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 in bacterial (RR: 1.7) or no infections (RR: 2.9). Estimate asymmetry was evident (p < 0.05). Up to 8 clusters and 5 outlier studies were identified on ML, and the estimate‐heterogeneity was eliminated by 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 the host criteria for defining IFIs.

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Prevalence, Predictors, and Outcomes of Esophageal Candidiasis in Cirrhosis: An Observational Study With Systematic Review and Meta-Analysis (CANDID-VIEW)

Cited by 7 publications

References 39 publications

Predictors for oesophageal candidiasis in patients with liver cirrhosis

Predictors for oesophageal candidiasis in patients with liver cirrhosis

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

Cirrhosis and fungal infections‐a cocktail for catastrophe: A systematic review and meta‐analysis with machine learning

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