Retrospective Cohort Study
Copyright ©The Author(s) 2024.
World J Hepatol. Mar 27, 2024; 16(3): 379-392
Published online Mar 27, 2024. doi: 10.4254/wjh.v16.i3.379
Table 1 Baseline cohort characteristics between liver intensive care unit patients with fungal and bacterial infections
Characteristic
Bacteria, n = 1831
Fungal, n = 271
P value2
Age60 (50, 66)58 (46, 66)0.3
Sex
Female73 (40)12 (44)
Male110 (60)15 (56)
Race
American Indian/Alaska Native1 (0.5)0 (0)
Asian1 (0.5)0 (0)
Black27 (15)6 (22)
Declined1 (0.5)2 (7.4)
Multiracial/cultural7 (3.8)1 (3.7)
Unavailable7 (3.8)1 (3.7)
White139 (76)17 (63)
Charlson Comorbidity Score6.00 (5.00, 7.00)6.00 (4.00, 7.00)0.3
Hepatocellular carcinoma 18 (9.8)1 (3.7)0.5
Principal liver diagnosis
Acute liver failure10 (5)2 (7.4)> 0.9
Cirrhosis 141 (78)21 (78)> 0.9
Alcohol-associated hepatitis (comorbid3)16 (9.3)6 (22)0.093
Acute severe liver injury/other434 (17)4 (14.6)> 0.9
Etiology of viral disease
Viral hepatitis24 (13)9 (33)0.016
Alcohol-associated75 (41)13 (48)0.6
Autoimmune8 (4.4)1 (3.7)> 0.9
NASH44 (24)5 (19)0.7
Primary biliary cholangitis4 (2.2)1 (3.7)> 0.9
Primary sclerosing cholangitis17 (9.3)1 (3.7)0.5
Other34 (19)6 (22)0.9
Toxins4 (2.2)0 (0)> 0.9
Ischemic injury5 (2.7)1 (3.7)> 0.9
Cryptogenic16 (8.7)1 (3.7)0.6
Decompensation defining events
Ascites144 (79)23 (85)0.6
Hepatic encephalopathy138 (75)25 (93)0.08
Hepatorenal syndrome63 (34)16 (59)0.023
EV history/variceal bleeding106 (58)16 (59)> 0.9
HPS2 (1.1)0 (0)> 0.9
PoPHTN6 (3.3)0 (0)0.7
Hepatic hydrothorax27 (15)3 (11)0.8
SBP45 (25)12 (44)0.053
Coagulopathy122 (67)21 (78)0.3
Thrombocytopenia107 (58)20 (74)0.2
1Median (IQR); n (%).
2Welch Two Sample t-test; Standardized Mean Difference; Two sample test for equality of proportions.
3Only 1 case of alcohol-associated hepatitis occurred without comorbid cirrhosis in bacterial cohort, not included in proportion shown.
4Other etiologies include chronic post-transplant patients with liver injury/recurrent portal hypertension, portal vein thrombosis, non-hepatitis viral infection and Caroli disease in conjunction with severe liver injury.
HPS: Hepatopulmonary syndrome; PoPTHN: Portopulmonary hypertension; SBP: Spontaneous bacterial peritonitis.
Table 2 Epidemiology of Candida isolates among patients with fungal patients in the intensive care unit
Organism
Urinary source
Bacteremia
Spontaneous peritonitis
Secondary peritonitis
Tracheitis
Total per organism
Candida glabrata-621-9
Candida albicans142-18
Candida krusei-2---2
Candida dubliniensis132--6
Candida (other)22---4
Total per source 417611
Table 3 Transplant and intensive care outcomes comparison between fungal and bacterial cohorts
Characteristic
Bacteria, n = 1831
Fungal, n = 271
P value2
Intensive care outcomes
ACLF grade0.017
< 250 (36)2 (9.5)
≥ 290 (64)19 (90)
Death during admission or hospice95 (52)25 (93)< 0.001
Vasopressor requirement 129 (70)26 (96)0.004
Mechanical ventilation 118 (65)26 (96)< 0.001
Indication for intubation
Airway protection93 (79)22 (85)0.6
Respiratory failure25 (21)4 (15)
Dialysis due to acute kidney injury 95 (52)21 (78)0.014
ICU LOS (d)5 (2, 10)6 (4, 16)0.063
Hospital LOS (d)16 (7, 28)17 (12, 30)0.3
Hosp admit to ICU (d) 0 (0, 6)8 (0, 13)0.046
Transplant-related outcomes
Evaluated for transplant107 (58)13 (48)0.3
Listed57 (53)4 (31)0.13
Organ listed0.3
Liver44 (79)3 (60)
Liver and kidney12 (21)2 (40)
Hold placed32 (57)4 (100)0.14
Transplant occurred28 (50)0 (0)0.056
1n (%); Range; Median (IQR).
2Pearson's Chi-squared test; Wilcoxon rank sum test; Fisher's exact test.
ACLF: Acute on chronic liver failure; ICU: Intensive care unit; LOS: Length of stay.
Table 4 Comparison of infection characteristics among liver patients in intensive care unit between fungal and bacterial cohorts
Characteristic
Bacteria, n = 1831
Fungal, n = 271
P value2
MDRO90 (50)10 (37)0.2
MELD-Na (time of positive culture)28 (22, 33)33 (25, 38)0.017
Child-Pugh score (time of positive culture)11.00 (9.00, 12.00)11.00 (10.00, 13.00)0.064
CLIF-C score (time of positive culture)11.00 (9.00, 13.00)13.00 (12.00, 14.50)< 0.001
Lab values of interest at time of culture
Leukocyte count 13 (7, 19)16 (11, 18)> 0.9
C-reactive protein6 (3, 12)5 (4, 8)0.057
Albumin2.70 (2.20, 3.30)3.10 (2.70, 3.40)0.086
Bilirubin6 (2, 13)13 (4, 23)0.035
Lactate2.9 (1.9, 5.2)4.4 (2.2, 7.3)0.3
International normalized ratio1.80 (1.40, 2.10)2.05 (1.78, 3.00)0.046
1n (%); Median (IQR).
2Pearson's Chi-squared test; Wilcoxon rank sum test; Fisher's exact test; Welch Two Sample test.
MDRO: Multi-drug resistant organism; MELD-Na: Model for End Stage Liver Disease-Sodium; CLIF: Chronic liver failure consortium organ failure score.
Table 5 Comparison of pre-infection variables between liver patients in intensive care unit with fungal and bacterial cohorts
Characteristic
Bacteria, n = 1831
Fungal, n = 271
P value2
APACHE III Score91 (71, 112)108 (96, 121)0.003
Acute Physiology Score65 (50, 90)86 (75, 108)0.003
MELD-Na (admission)29 (23, 35)32 (28, 38)0.041
Stress dose steroid use in past 3 months29 (16)6 (22)0.4
Foley in past 48 h80 (44)5 (19)0.013
Central line in past 48 h 73 (40)14 (52)0.2
Positive MRSA nasal swab15 (8.2)5 (19)0.15
Prior MDRO infection/colonization39 (21)11 (41)0.027
Regular LVP72 (39)14 (52)0.2
Immunosuppressive medications (at time of admission)40 (22)6 (22)> 0.9
Charlson Comorbidity Score6.00 (5.00, 7.00)6.00 (4.00, 7.00)0.5
Prior antibiotic classes exposed4.00 (3.00, 5.00)4.00 (3.00, 5.00)0.9
Prior antifungal classes exposed0.11
0104 (57)10 (37)
158 (32)14 (52)
216 (8.8)2 (7.4)
33 (1.7)1 (3.7)
COVID within 30 d prior 9 (4.9)2 (7.4)0.6
1n (%); Median (IQR).
2Pearson's Chi-squared test; Wilcoxon rank sum test; Fisher's exact test.
MRSA: Methicillin-resistant Staphylococcus aureus; MDRO: Multi-drug resistant organism; LVP: Large-volume paracentesis; MELD-Na: Model for End Stage Liver Disease-Sodium; APACHE: Acute Physiology and Chronic Health Evaluation.