Introduction: Cirrhosis has been identified as a risk factor for the development of candidemia, which is associated with high mortality rates. Although the current literature describes poor outcomes in cirrhotic patients with invasive candidiasis, factors contributing to worse outcomes are not well known. We aim to better understand the factors contributing to worse outcomes in cirrhotic patients with candidemia.
Methods: Data were extracted from the National Inpatient Sample (NIS) database from 2016-2019. Using the ICD-10-CM codes, patients diagnosed with candidemia were identified. Baseline demographic data, comorbidities, in-hospital mortality, hospital charges, and hospital length of stay (LOS) were extracted and compared based on the presence or absence of a concurrent diagnosis of cirrhosis. Statistical analyses were done using t-test and Chi-squared analysis. A multivariate analysis for the mortality odds ratio (OR) was calculated to adjust for possible confounders.
Results: A total of 49,130 patients diagnosed with candidemia, and 2,650 of them had a concurrent diagnosis of cirrhosis. There was no difference in the cost of hospitalization ($ 319,472 vs. $ 315,338; p = 0.86) or the LOS (21.6 vs 21.7 days; p = 0.91). Cirrhotic patients had a higher in-hospital mortality than those without cirrhosis (OR 2.43, CI 1.94-3.02; p = 0.01). Moreover, age >65, non-white race, alcoholism, and congestive heart failure were independently associated with a higher in-hospital mortality (Table 1). In patients with cirrhosis and candidemia, the presence of hepatic failure (OR 2.4, CI 1.63-3.53; p = 0.00) and ascites (OR 1.64, CI 1.11-2.45; p = 0.01) were associated with increased mortality. Other comorbidities such as hepatorenal syndrome, hepatopulmonary syndrome, spontaneous bacterial peritonitis, hepatocellular carcinoma, and esophageal varices did not have an association.
Discussion: A co-diagnosis of cirrhosis during hospitalization for candidemia may indicate a poor prognosis, especially in those with associated hepatic failure and ascites, and thus a careful clinical judgement should be practiced given the nature of cirrhosis may complicate the management of infection. Modifiable risk factors such as alcoholism and underlying socioeconomic factors may play key roles in disease outcomes and should be addressed to avoid excessively poor healthcare outcomes.
