Clinical characteristics and outcomes of invasive fungal infections in critically ill patients with liver cirrhosis

Background & aims Invasive fungal infections (IFIs) are increasingly recognized as a severe and often underdiagnosed complication in critically ill patients with liver cirrhosis. Cirrhosis-associated immune dysfunction, and advanced disease stage contribute to an elevated risk, particularly in the intensive care unit (ICU). Despite their high mortality, data on the epidemiology and timing of IFIs in ICU-treated cirrhotic patients remain limited. We aimed to determine the prevalence, timing, and impact of IFIs on 30- and 90-day survival in this high-risk population. Methods This retrospective single-center cohort study included 488 patients with liver cirrhosis who were admitted to ICU between January 2014 and December 2019. Patients were evaluated for the presence of IFIs during their hospital stay and stratified into Non-IFI ( n = 458) and IFI ( n = 30) groups. Comparative analyses were performed with a specific focus on invasive candidiasis and invasive pulmonary aspergillosis. Results IFI prevalence was 6.1%. Invasive candidiasis and invasive pulmonary aspergillosis were diagnosed in 46.7% and 53.3% of IFI cases, with a median onset of 14.5 (6.50–24.00) and 17.5 (7.75-36.00) days, respectively. IFI patients had significantly more advanced liver disease reflected by higher MELD ( p < 0.001) score and more severe ACLF ( p = 0.009) and required significantly more invasive procedures such as dialysis ( p < 0.001) parenteral nutrition ( p < 0.001), and mechanical ventilation ( p = 0.002). In addition, bacterial infections at admission were more common in IFI patients. The occurrence of IFI was associated with significantly reduced 30- and 90-day survival, particularly in patients with ACLF. Conclusion These findings highlight the need for IFI surveillance in critically ill cirrhosis patients, particularly in those with ACLF and bacterial infections at admission.