TOPLINE:

Invasive fungal diseases (IFDs) affect approximately 1 in 50 patients with complicated alcohol-related hepatitis (CAH) and are associated with a more than fourfold increase in mortality risk.

METHODOLOGY:

• Clear management protocols exist for bacterial pneumonia in patients with CAH, but the burden of IFDs is poorly characterized.
• Researchers analyzed 81,156 adults diagnosed with alcohol-related hepatitis in France between 2012 and 2021 to compare the burden of IFDs with bacterial pneumonia.
• They focused their analysis on the subpopulation with CAH, defined by at least two markers of hepatic (ascites, jaundice, hepatic failure, or hepatic encephalopathy) or extrahepatic (coagulopathy, shock, acute kidney injury, or acute respiratory failure) organ dysfunction within 30 days of diagnosis.
• IFDs were defined as pneumocystosis, invasive candidiasis, invasive aspergillosis, or cryptococcosis occurring within 12 weeks of CAH diagnosis.
• The primary outcome was 3-month mortality or liver transplantation, with a risk for IFDs as a secondary outcome.

TAKEAWAY:

• Among 11,434 patients identified with CAH (median age, 55 years; 71.8% men), IFDs and bacterial pneumonia were diagnosed in 2.2% and 15.6%, respectively, vs 0.3% and 4% of those without CAH (P < .001 for both).
• At 12 weeks, survival was 17.5% with IFDs, 46.8% with bacterial pneumonia, and 60.0% with neither condition.
• In matched analyses, IFDs were linked to a more than fourfold higher mortality risk (adjusted odds ratio [aOR], 4.58; P < .001), whereas bacterial pneumonia showed only a modest rise (aOR, 1.23; P = .006). Bacterial pneumonia also increased the risk for subsequent IFDs (aOR, 2.91; P < .001).
• IFDs emerged as strong predictors of mortality over time (adjusted hazard ratio, 5.94; P = .0032) despite no significant baseline association.

IN PRACTICE:

“These findings support the urgent need for evidence-based guidelines on systematic screening and risk-adapted antifungal prophylaxis in CAH,” the authors of the study wrote, adding that, “bacterial pneumonia may serve as a clinical sentinel for fungal superinfection.”

SOURCE:

The study was led by Charlotte Mouliade, MD, AP-HP. Centre, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et Spécialités Médico-Chirurgicales, Service Des Maladies du Foie, Paris, France. It was published online in Alimentary Pharmacology and Therapeutics.

LIMITATIONS:

IFDs were identified via diagnostic codes rather than microbiologic/histopathologic confirmation, which could underestimate actual prevalence. Precise timing for key clinical events (diagnosis of CAH, corticosteroid initiation, IFD onset) was unavailable, as was information on antifungal/antibiotic therapies.

DISCLOSURES:

No study funding was reported. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.