Bassetti et al identified factors associated with mortality of cirrhotic patients with candidemia and intra-abdominal candidiasis. The authors are from multiple institutions in Europe and Brazil.
Patient selection: cirrhosis with candidemia and intra-abdominal candidiasis
Mortality rate: 35% in 30 days
Candida species usually involved:
(1) Candida albicans
(2) Candida glabrata
(3) Candida parapsilosis
Predictors of mortality:
(1) septic shock (odds ratio 3.2)
(2) inadequate antifungal therapy (odds ratio 2.5; adequate antifungal therapy has odds ratio 0.4)
where:
• Antifungal therapy was considered adequate if the organism is susceptible to the antifungal agent and the dosage is adequate.
• Nonsurvivors had a mean duration of antifungal therapy of 6 days vs 16 for survivors.
The authors list candidemia as a risk factor (odds ratio 2.2) although this is listed as an inclusion criteria.
The severity of the cirrhosis would also seem to be a predictor of mortality. Nonsurvivors had a higher rate of hepatic encephalopathy and MELD score > 25.
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