Dr Khan recaps the results of research at Cleveland Clinic on how patients with acute-on-chronic liver failure with bacterial infections vs fungal infections fared in terms of mortality and other metrics.

Sarah Khan, MD, is a resident in internal medicine with a focus on hepatology and GI research at Cleveland Clinic in Cleveland, Ohio.

TRANSCRIPT:

Dr. Sarah Kahn:

Hello everyone. My name is Dr. Sarah Kahn, I'm here at DDW in Chicago presenting our work from the Medical Liver Intensive Unit at Cleveland Clinic.

We conducted a study examining patients with positive cultures who were admitted to the Medical Liver Intensive Unit between 2018 to 2022. We compared patients with fungal infection to their bacterial infected counterparts, and examined outcomes of mortality, peritransplant outcomes, ICU length of stay, as well as potential predisposing factors for infection, and markers of disease severity at time of infection.

We found that among patients with fungal infection all were infected with candidal species, the most common being candida glabrata, followed by candida albicans. We found that relative to their bacterial counterparts, patients with fungal infection had significantly lower survival with the median survival following ICU admission of 12 days. We found no differences in ICU length of state or hospital length of stay.

Notably, patients with fungal infection relative to bacterial counterparts overwhelmingly had severe grades of acute on chronic liver failure, or ACLF, with 90% of patients with fungal infection having ACLF grades two or three. We also found that at time of ICU admission, even prior to development of a positive fungal culture, patients with fungal infection had higher disease severity indices, including higher MELD sodium score, higher APS scores, and higher APACHE scores.

Following admission at time of positive culture, we found that patients with fungal infection also had higher grades ACLF further increase in their MELD sodium scores and other disease severe indices, including clip C scores. We found that patients with fungal infection had higher bilirubin and INR, and our study raises the question of whether higher ACLF is associated with increased risk of fungal infection or whether fungal infection predisposes to higher grades of ACLF?

We feel that further studies examining this relationship would be crucial to improving patient care as well as coming to a consensus on the timing and indication for empiric or even prophylactic antifungal coverage. Be it a certain ACLF grade MELD score, APACHE score, or perhaps markers of worsening immunodeficiency among these patients.

Thank you so much for listening.