In patients with cirrhosis, or liver scarring, infections are associated with poor outcomes and a very high death rate, report researchers at MUSC's听 (DDRC) in The American Journal of Medical Sciences. Their findings also raise the possibility that physicians may not be treating these patients for the right types of infections.

The MUSC research team, led by DDRC director , reviewed the medical records of 877 patients who were hospitalized with cirrhosis. The study found that 20% of the patients died from infections, and that about 12% of all infections came from fungal organisms.

鈥淭here are serious infections lurking in patients with cirrhosis. It鈥檚 not until the patient is spiraling downward and doing poorly that doctors think about these fungal infections." -- Dr. Don Rockey

Every 24 hours, the liver filters approximately 45 gallons of blood, which is full of nutrients but also contains bacteria, fungi and other compounds. In the healthy liver, specialized cells known as Kupffer cells remove harmful bacteria and/or fungi. 听However, when the liver becomes cirrhotic, or scarred, Kupffer cells don鈥檛 function normally, said Rockey, leaving patients at increased risk for infection.

Prior to the MUSC study, fungal infections were thought to be uncommon in patients with cirrhosis. The high frequency of fungal infections found in the study has implications for patient care.

鈥淒octors caring for these patients don鈥檛 routinely think about fungal infections鈥� said Rockey.

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Since doctors may not anticipate seeing fungal infections in their patients, they tend to treat for other types of infections first. Fungal infections are resistant to typical antibiotics that are prescribed for bacterial infections. As a result, by the time doctors begin to suspect a fungal infection, it is often too late for effective treatment.

鈥淭here are serious infections lurking in patients with cirrhosis,鈥� said Rockey. 鈥淚t鈥檚 not until the patient is spiraling downward and doing poorly that doctors think about these fungal infections. Thus, the findings from this study emphasize how important it is for doctors to think about these organisms early.鈥�

Rockey believes it is also important to inform patients with cirrhosis that infections can be deadly.

鈥淪adly, the average patient with cirrhosis does not understand that they are immunocompromised, which means they are less able to fight infections,鈥� said Rockey.

Rockey emphasized that patients with cirrhosis need to be proactive when it comes to infection.

鈥淚f patients with cirrhosis think they have an infection or aren鈥檛 doing well 鈥� no matter the reason 鈥� they need to get to their doctor or to an emergency room promptly,鈥� said Rockey. 鈥淚nfections are the leading cause of death right now for patients with cirrhosis.鈥�

Reference

Choudry N, Sasso R, Rockey DC. Infection in Hospitalized Cirrhosis Patients: Changing Epidemiology and Clinical Features. Am J Med Sci. 2022 Jan 4:S0002-9629(21)00449-3. doi: . Epub ahead of print. PMID: 34995572.