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
ARTICLE HIGHLIGHTS
Research background

Spontaneous peritonitis is one of the most common infectious complications in cirrhotic patients with ascites. However, spontaneous fungal peritonitis is a less recognized but devastating complication in end-stage cirrhosis.

Research motivation

To improve the survival rate, it is crucial to identify the risk factors for occurrence and mortality and to optimize stratification. Additionally, recognizing the clinical features is critical for the early diagnosis of spontaneous fungal peritonitis (SFP).

Research objectives

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

Research methods

In this case-control study, 138 cirrhotic patients with spontaneous peritonitis were recruited. Patients with SFP were included in a case group. Sex-, age-, and time-matched SBP patients were included in a control group. Furthermore, the control group was divided into control-1 group (positive bacterial culture) and control-2 group (negative bacterial culture), according to the bacterial culture result. Differences in the clinical features, laboratory examinations, severity models, and prognosis were compared between the case and control groups. The risk factors for the occurrence of SFP were identified by the logistic regression model. The short-term mortality of SFP was determined by the Cox regression model. Additionally, the predictive ability of different prognostic scoring systems was evaluated.

Research results

Patients with SFP had severe systemic inflammation, including higher white blood cell counts and C-reaction protein levels, and exhibited poor short-term mortality. However, no significant difference was found regarding the short-term mortality between patients with SFP and fungiascites. Long-term antibiotic administration dramatically increased the occurrence of SFP or fungiascites. The median length of antibiotic administration before the occurrence of SFP or fungiascites was 12 d in our study. 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.

Research conclusion

The present study found that long-term antibiotic administration increases the incidence of SFP and that hepatorenal syndrome and total bilirubin are closely related to short-term mortality.

Research prospective

Although a large sample size is required for further evaluation, our investigation provides a comprehensive study on characterizing the clinical features of SFP.