Analysis of risk factors for end-stage liver disease complicated with fungal esophagitis_West China Medical Journal

Authors：

YU Min , LEI Yu , ZHONG Shan , DENG Huan ,  ZHOU Zhi

Department of Infectious Diseases, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China;

Corresponding author：

ZHOU Zhi, Email: zhouzhi2300@126.com

Keywords：

End-stage liver disease; fungal esophagitis; risk factor

DOI：

10.7507/1002-0179.202410183

Video：

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Objective To investigate the risk factors for end-stage liver disease (ESLD) complicated with fungal esophagitis (FE). Methods The clinical data of ESLD patients who underwent gastroscopy during their hospitalization in the Second Affiliated Hospital of Chongqing Medical University between January 1, 2017 and December 31, 2023 were retrospectively analyzed. The ESLD patients with FE were selected as the study group, and the ESLD patients without FE during the same period were included as the control group by 1∶2 propensity score matching method. Multivariate logistic regression model was used to analyze the risk factors of ESLD complicated with FE. Results A total of 75 ESLD patients with FE and 150 ESLD patients without FE were enrolled. There were no significant differences in age, gender, decompensated cirrhosis, liver cancer, diabetes mellitus, and etiology of ESLD between the two groups (P>0.05). Multivariate logistic regression analysis showed that longer hospital stay [odds ratio (OR)=1.115, 95% confidence interval (CI) (1.069, 1.164)], with invasive procedures [OR=10.820, 95%CI (4.393, 26.647)], and higher total bilirubin [OR=1.015, 95%CI (1.005, 1.024)] were risk factors for ESLD complicated with FE (P<0.05). In the study group, 41 patients were treated with antifungal drugs, and 4 of them developed invasive fungal infection. Among the 34 patients who did not receive antifungal drugs, 10 developed invasive fungal infection. Conclusions ESLD patients with longer hospital stay, worse liver function, and invasive procedures are more likely to develop FE, and regular gastroscopy should be performed. Once FE is found, active antifungal treatment should be taken to reduce the occurrence of invasive fungal infection and improve the prognosis of patients.

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2.	Cheruvattath R, Balan V. Infections in patients with end-stage liver disease. J Clin Gastroenterol, 2007, 41(4): 403-411.
3.	李秀喜. 终末期肝病合并感染诊治的难点分析. 医学食疗与健康, 2021, 19(13): 216-217.
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5.	Kanzaki R, Yano M, Takachi K, et al. Candida esophagitis complicated by an esophago-airway fistula: report of a case. Surg Today, 2009, 39(11): 972-978.
6.	Mellinghoff SC, Cornely OA, Jung N. Essentials in candida bloodstream infection. Infection, 2018, 46(6): 897-899.
7.	Zillessen E, Palme W, Feichter GE. Candidiasis of the esophagus. Prospective study of incidence, type of complaints and predisposing factors. Dtsch Med Wochenschr, 1986, 111(31/32): 1200-1207.
8.	Rosołowski M, Kierzkiewicz M. Etiology, diagnosis and treatment of infectious esophagitis. Prz Gastroenterol, 2013, 8(6): 333-337.
9.	Alsomali MI, Arnold MA, Frankel WL, et al. Challenges to “classic” esophageal candidiasis: looks are usually deceiving. Am J Clin Pathol, 2017, 147(1): 33-42.
10.	Verma N, Mishra S, Singh S, et al. Prevalence, predictors, and outcomes of esophageal candidiasis in cirrhosis: an observational study with systematic review and meta-analysis (CANDID-VIEW). J Clin Exp Hepatol, 2022, 12(1): 118-128.
11.	Alexopoulou A, Vasilieva L, Agiasotelli D, et al. Fungal infections in patients with cirrhosis. J Hepatol, 2015, 63(4): 1043-1045.
12.	Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg, 1973, 60(8): 646-649.
13.	Kamath PS, Kim WR, Advanced Liver Disease Study Group. The model for end-stage liver disease (MELD). Hepatology, 2007, 45(3): 797-805.
14.	中国研究型医院学会肝病专业委员会重症肝病学组, 中华医学会肝病学分会重型肝病与人工肝学组. 重症肝病合并侵袭性真菌感染诊治专家共识. 临床肝胆病杂志, 2022, 38(2): 311-317.
15.	Xie K, Chen CH, Tsai SP, et al. Loss of life expectancy by 10 years or more from elevated aspartate aminotransferase: finding aspartate aminotransferase a better mortality predictor for all-cause and liver-related than alanine aminotransferase. Am J Gastroenterol, 2019, 114(9): 1478-1487.
16.	吴梦晗, 张慧慧, 黄斌, 等. 脓毒症患者血清总胆红素水平的动态变化及临床价值分析. 心脑血管病防治, 2021, 21(3): 230-233.
17.	黄冬琴, 覃韬, 谢显龙, 等. 脓毒症院内死亡与肝功能的关系及危险因素分析. 广东医学, 2018, 39(5): 725-729.
18.	Wu YP, Li FC, Ma HY, et al. Characteristics and risk factors for invasive fungal infection in hospitalized patients with acute-on-chronic hepatitis B liver failure: a retrospective cohort study from 2010 to 2023. Front Microbiol, 2024, 15: 1391814.
19.	梁东. 肝衰竭并发医院内真菌感染 36 例临床分析. 中国热带医学, 2015, 15(12): 1510-1512.
20.	张黎, 刘正印. 终末期肝病与侵袭性真菌感染. 中华肝脏病杂志, 2018, 26(1): 13-16.
21.	姜天俊, 闫子国, 赵敏, 等. 晚期肝病患者并发真菌感染的早期预警指标研究. 临床肝胆病杂志, 2007, 23(5): 362-364.
22.	Hassan EA, Abd El-Rehim AS, Hassany SM, et al. Fungal infection in patients with end-stage liver disease: low frequency or low index of suspicion. Int J Infect Dis, 2014, 23: 69-74.
23.	Malinchoc M, Kamath PS, Gordon FD, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology, 2000, 31(4): 864-871.
24.	Asrani SK, Kim WR. Model for end-stage liver disease: end of the first decade. Clin Liver Dis, 2011, 15(4): 685-698.
25.	Peng Y, Qi X, Guo X. Child-Pugh versus MELD score for the assessment of prognosis in liver cirrhosis: a systematic review and meta-analysis of observational studies. Medicine (Baltimore), 2016, 95(8): e2877.
26.	Nanchal RS, Ahmad S. Infections in liver disease. Crit Care Clin, 2016, 32(3): 411-424.
27.	Kim BS, Lee SG, Hwang S, et al. Influence of pretransplantation bacterial and fungal culture positivity on outcome after living donor liver transplantation. Transplant Proc, 2009, 41(1): 250-252.
28.	Habib S, Yarlagadda S, Carreon TA, et al. Fungal infection in acutely decompensated cirrhosis patients: value of model for end-stage liver disease score. Gastroenterology Res, 2020, 13(5): 199-207.
29.	Sánchez-Fayos Calabuig P, Martín Relloso MJ, Porres Cubero JC. Gastric mucosa as a target of persistent proinflammatory aggression: pathogenic models of chronic gastritis. Gastroenterol Hepatol, 2009, 32(4): 294-306.

1. 陈韬, 宁琴. 终末期肝病合并感染诊治的热点与难点. 中华临床感染病杂志, 2017, 10(5): 389-393.
2. Cheruvattath R, Balan V. Infections in patients with end-stage liver disease. J Clin Gastroenterol, 2007, 41(4): 403-411.
3. 李秀喜. 终末期肝病合并感染诊治的难点分析. 医学食疗与健康, 2021, 19(13): 216-217.
4. Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis, 2016, 62(4): e1-e50.
5. Kanzaki R, Yano M, Takachi K, et al. Candida esophagitis complicated by an esophago-airway fistula: report of a case. Surg Today, 2009, 39(11): 972-978.
6. Mellinghoff SC, Cornely OA, Jung N. Essentials in candida bloodstream infection. Infection, 2018, 46(6): 897-899.
7. Zillessen E, Palme W, Feichter GE. Candidiasis of the esophagus. Prospective study of incidence, type of complaints and predisposing factors. Dtsch Med Wochenschr, 1986, 111(31/32): 1200-1207.
8. Rosołowski M, Kierzkiewicz M. Etiology, diagnosis and treatment of infectious esophagitis. Prz Gastroenterol, 2013, 8(6): 333-337.
9. Alsomali MI, Arnold MA, Frankel WL, et al. Challenges to “classic” esophageal candidiasis: looks are usually deceiving. Am J Clin Pathol, 2017, 147(1): 33-42.
10. Verma N, Mishra S, Singh S, et al. Prevalence, predictors, and outcomes of esophageal candidiasis in cirrhosis: an observational study with systematic review and meta-analysis (CANDID-VIEW). J Clin Exp Hepatol, 2022, 12(1): 118-128.
11. Alexopoulou A, Vasilieva L, Agiasotelli D, et al. Fungal infections in patients with cirrhosis. J Hepatol, 2015, 63(4): 1043-1045.
12. Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg, 1973, 60(8): 646-649.
13. Kamath PS, Kim WR, Advanced Liver Disease Study Group. The model for end-stage liver disease (MELD). Hepatology, 2007, 45(3): 797-805.
14. 中国研究型医院学会肝病专业委员会重症肝病学组, 中华医学会肝病学分会重型肝病与人工肝学组. 重症肝病合并侵袭性真菌感染诊治专家共识. 临床肝胆病杂志, 2022, 38(2): 311-317.
15. Xie K, Chen CH, Tsai SP, et al. Loss of life expectancy by 10 years or more from elevated aspartate aminotransferase: finding aspartate aminotransferase a better mortality predictor for all-cause and liver-related than alanine aminotransferase. Am J Gastroenterol, 2019, 114(9): 1478-1487.
16. 吴梦晗, 张慧慧, 黄斌, 等. 脓毒症患者血清总胆红素水平的动态变化及临床价值分析. 心脑血管病防治, 2021, 21(3): 230-233.
17. 黄冬琴, 覃韬, 谢显龙, 等. 脓毒症院内死亡与肝功能的关系及危险因素分析. 广东医学, 2018, 39(5): 725-729.
18. Wu YP, Li FC, Ma HY, et al. Characteristics and risk factors for invasive fungal infection in hospitalized patients with acute-on-chronic hepatitis B liver failure: a retrospective cohort study from 2010 to 2023. Front Microbiol, 2024, 15: 1391814.
19. 梁东. 肝衰竭并发医院内真菌感染 36 例临床分析. 中国热带医学, 2015, 15(12): 1510-1512.
20. 张黎, 刘正印. 终末期肝病与侵袭性真菌感染. 中华肝脏病杂志, 2018, 26(1): 13-16.
21. 姜天俊, 闫子国, 赵敏, 等. 晚期肝病患者并发真菌感染的早期预警指标研究. 临床肝胆病杂志, 2007, 23(5): 362-364.
22. Hassan EA, Abd El-Rehim AS, Hassany SM, et al. Fungal infection in patients with end-stage liver disease: low frequency or low index of suspicion. Int J Infect Dis, 2014, 23: 69-74.
23. Malinchoc M, Kamath PS, Gordon FD, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology, 2000, 31(4): 864-871.
24. Asrani SK, Kim WR. Model for end-stage liver disease: end of the first decade. Clin Liver Dis, 2011, 15(4): 685-698.
25. Peng Y, Qi X, Guo X. Child-Pugh versus MELD score for the assessment of prognosis in liver cirrhosis: a systematic review and meta-analysis of observational studies. Medicine (Baltimore), 2016, 95(8): e2877.
26. Nanchal RS, Ahmad S. Infections in liver disease. Crit Care Clin, 2016, 32(3): 411-424.
27. Kim BS, Lee SG, Hwang S, et al. Influence of pretransplantation bacterial and fungal culture positivity on outcome after living donor liver transplantation. Transplant Proc, 2009, 41(1): 250-252.
28. Habib S, Yarlagadda S, Carreon TA, et al. Fungal infection in acutely decompensated cirrhosis patients: value of model for end-stage liver disease score. Gastroenterology Res, 2020, 13(5): 199-207.
29. Sánchez-Fayos Calabuig P, Martín Relloso MJ, Porres Cubero JC. Gastric mucosa as a target of persistent proinflammatory aggression: pathogenic models of chronic gastritis. Gastroenterol Hepatol, 2009, 32(4): 294-306.

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