Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2019; 7(17): 2438-2449
Published online Sep 6, 2019. doi: 10.12998/wjcc.v7.i17.2438
Risk factors, clinical features, and short-term prognosis of spontaneous fungal peritonitis in cirrhosis: A matched case-control study
Chun-Hong Huang, Lan-Tian Pang, Li-Chen Xu, Tian-Tian Ge, Qiao-Mai Xu, Zhi Chen
Chun-Hong Huang, Lan-Tian Pang, Li-Chen Xu, Tian-Tian Ge, Qiao-Mai Xu, Zhi Chen, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Author contributions: Huang CH and Pang LT wrote the paper; Pang LT, Ge TT, Xu QM, and Xu LC performed data collection; Xu LC and Huang CH participated in the design of the study and analysed the data; Chen Z conceived the study, participated in study design and coordination, and helped draft the manuscript; Ge TT prepared the figures; all the authors read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the institutional review board of The First Affiliated Hospital, Zhejiang University School of Medicine (No. 17-615).
Informed consent statement: Informed consent for this study was not required because the analysis used anonymous clinical data that were obtained after each patient agreed to be treated by written consent.
Conflict-of-interest statement: The authors declare that no competing interest exists.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhi Chen, MD, PhD, Professor, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. zjuchenzhi@zju.edu.cn
Telephone: +86-571-86971280
Received: May 14, 2019
Peer-review started: May 14, 2019
First decision: June 9, 2019
Revised: July 12, 2019
Accepted: July 27, 2019
Article in press: July 27, 2019
Published online: September 6, 2019
Processing time: 116 Days and 7.2 Hours
Abstract
BACKGROUND

Spontaneous peritonitis is one of the most common infectious complications in cirrhotic patients with ascites. Spontaneous fungal peritonitis (SFP) is a type of spontaneous peritonitis that is a less recognized but devastating complication in end-stage cirrhosis. Although high mortality was previously noted, scant data are available to fully define the factors responsible for the occurrence of SFP and its mortality.

AIM

To illustrate the differences between SFP and spontaneous bacterial peritonitis (SBP) and discuss the risk factors for the occurrence of SFP and its short-term mortality.

METHODS

We performed a matched case-control study between January 1, 2007 and December 30, 2018. Patients with SFP were included in a case group. Sex-, age-, and time-matched patients with SBP were included in a control group and were further divided into control-1 group (positive bacterial culture) and control-2 group (negative bacterial culture). The clinical features and laboratory parameters, severity models, and prognosis were compared between the case and control groups. Logistic regression analysis was used to determine the risk factors for occurrence, and the Cox regression model was used to identify the predictive factors for short-term mortality of SFP.

RESULTS

Patients with SFP exhibited more severe systemic inflammation, higher ascites albumin and polymorphonuclear neutrophils, and a worsened 15-d mortality than patients in the control groups. Antibiotic administration (case vs control-1: OR = 1.063, 95%CI: 1.012-1.115, P = 0.014; case vs control-2: OR = 1.054, 95%CI: 1.014-1.095, P = 0.008) remarkably increased the occurrence of SFP or fungiascites. Hepatorenal syndrome (HR = 5.328, 95%CI: 1.050-18.900) and total bilirubin (μmol/L; HR = 1.005, 95%CI: 1.002-1.008) represented independent predictors of SFP-related early mortality.

CONCLUSION

Long-term antibiotic administration increases the incidence of SFP, and hepatorenal syndrome and total bilirubin are closely related to short-term mortality.

Keywords: Spontaneous fungal peritonitis; Risk factor; Cirrhosis

Core tip: Spontaneous fungal peritonitis (SFP) is a less recognized but severe complication in cirrhotic patients. In this retrospective study, we found that patients with SFP exhibited more severe systemic inflammation, higher ascites albumin and polymorphonuclear neutrophils, and a worsened 15-d mortality than patients with spontaneous bacterial peritonitis. Long-term antibiotic administration increases the incidence of SFP, while hepatorenal syndrome and total bilirubin are valuable in predicting short-term mortality.