ABSTRACT Background The burden of invasive fungal diseases (IFDs) in patients with complicated alcoholic hepatitis (CAH)—defined by ≥ 2 hepatic (ascites, jaundice, liver failure, encephalopathy) or extrahepatic (coagulopathy, shock, kidney or respiratory failure) dysfunctions within 30 days—remains poorly characterised. Aims To assess the burden of IFDs in CAH and compare it with bacterial pneumonia (BP). Methods We conducted a retrospective nationwide cohort study of adult CAH patients in France (2012–2021). The primary exposure were IFDs. The primary outcome was 3‐month mortality or liver transplantation. Associations were assessed with adjusted odds ratios (aORs) in complete‐case and propensity score–matched cohorts. A 6‐week landmark analysis and time‐dependent Cox models were used to evaluate time‐varying effects. Results Among 11,434 CAH patients (median age 55 years; 72% male), 2.2% and 15% developed IFDs and BP, respectively. Three‐month survival was 17.5% (95% CI: 13.0–23.0) in IFDs, 46.8% (44.3–49.3) in BP and 60.0% (59.4–61.4) in those without either ( p < 0.001). IFDs occurred in 44.3% of patients with BP, and BP increased IFD risk (aOR 2.93, 95% CI: 2.23–3.84). In matched analyses, IFDs were associated with a fourfold increase in mortality (aOR 4.58, 95% CI: 3.02–7.20), while BP showed a lower association (aOR 1.23, 95% CI: 1.06–1.43). IFDs were strong time‐dependent predictors of death. Conclusions IFDs affected 1 in 50 CAH patients and carried a disproportionate mortality risk, compared with BP. These findings support the implementation of targeted screening and early antifungal strategies in CAH management, as for BP.
Mouliade et al. (Mon,) studied this question.