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Cirrhosis and fungal infections-a cocktail for catastrophe: A systematic review and meta-analysis with machine learning.
Verma, Nipun; Singh, Shreya; Roy, Akash; Valsan, Arun; Garg, Pratibha; Pradhan, Pranita; Chakrabarti, Arunaloke; Singh, Meenu.
  • Verma N; Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
  • Singh S; Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
  • Roy A; Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
  • Valsan A; Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
  • Garg P; Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
  • Pradhan P; Indian Council of Medical Research Center for evidence based child health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
  • Chakrabarti A; Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
  • Singh M; Indian Council of Medical Research Center for evidence based child health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Mycoses ; 65(9): 844-858, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2019541
ABSTRACT

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 289%, 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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Full text: Available Collection: International databases Database: MEDLINE Main subject: Bacterial Infections / Mycoses Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Long Covid Limits: Humans Language: English Journal: Mycoses Journal subject: Microbiology Year: 2022 Document Type: Article Affiliation country: Myc.13482

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Bacterial Infections / Mycoses Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Long Covid Limits: Humans Language: English Journal: Mycoses Journal subject: Microbiology Year: 2022 Document Type: Article Affiliation country: Myc.13482