{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:01:23Z","timestamp":1792000883966,"version":"4.4.0"},"reference-count":71,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,12,5]],"date-time":"2021-12-05T00:00:00Z","timestamp":1638662400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001411","name":"Indian Council of Medical Research","doi-asserted-by":"publisher","award":["ICMR\/5\/7\/1668\/CH\/CAR\/2019\u2010RBMCH"],"award-info":[{"award-number":["ICMR\/5\/7\/1668\/CH\/CAR\/2019\u2010RBMCH"]}],"id":[{"id":"10.13039\/501100001411","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aims<\/jats:title><jats:p>Fungal infections (FIs) have serious implications, yet understated in cirrhosis. Therefore, we reviewed the epidemiology and trends of FIs among cirrhotics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Four electronic databases were searched for full\u2010text articles describing prevalence of FIs in cirrhosis. Studies from post\u2010transplant, malignancy and classical\u2010immuno\u2010deficiency patients were excluded. A random\u2010effects meta\u2010analysis was done to pool estimates of FIs (overall, and by type and infection\u2010site), and their variation(I<jats:sup>2<\/jats:sup>) was explored on moderator\u2010analysis and meta\u2010regression. Risk of bias and asymmetry in estimates was assessed by a checklist and Egger's regression, respectively.(CRD42019142782).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010four low\u2010risk and four moderate\u2010risk studies (31\u00a0984 cirrhotics) were included. Pooled estimates of overall FIs (17 studies), invasive fungal infections (IFIs; 17 studies), invasive candidiasis (23 studies) and invasive aspergillosis (16 studies) in cirrhosis were 10.2%(6.0\u201016.9), 9.5%(5.4\u201016.2), 4.0%(2.0\u20108.0) and 2.8%(1.5\u20105.3), respectively (I<jats:sup>2<\/jats:sup>\u00a0&gt;\u00a090%;each). Site of FIs in decreasing order of pooled prevalence was pulmonary, urinary tract, bloodstream, peritoneal, oesophageal and cerebral. Geographic differences in these estimates were remarkable, with highest burden of overall FIs from Belgium, the United States and India. Non\u2010albicans\u2010<jats:italic>Candida<\/jats:italic> and <jats:italic>Aspergillus<\/jats:italic> infections have increased over the last decade in cirrhosis. Intensive\u2010care\u2010unit (ICU)\u2010admitted and acute\u2010on\u2010chronic liver failure (ACLF) patients had the highest prevalence of IFIs. MELD score(cases), bias score and sample size across studies were the predictors of variance in overall FI estimates.\u00a0Diabetes, steroid and broad\u2010spectrum antibiotic\u2010exposure, and multiple organ failures were the common predispositions reported in patients with FIs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>FIs impose a substantial burden in cirrhosis. ACLF and ICU admission should be considered as a host factor for defining IFIs. Epidemiology of FIs can guide interpretation of biomarkers and antifungal treatment in cirrhosis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/myc.13387","type":"journal-article","created":{"date-parts":[[2021,11,1]],"date-time":"2021-11-01T16:53:41Z","timestamp":1635785621000},"page":"266-284","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Global epidemiological burden of fungal infections in cirrhosis patients: A systematic review with meta\u2010analysis"],"prefix":"10.1111","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4328-0914","authenticated-orcid":false,"given":"Nipun","family":"Verma","sequence":"first","affiliation":[{"name":"Department of Hepatology Postgraduate Institute of Medical Education and Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shreya","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology Postgraduate Institute of Medical Education and Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9653-1708","authenticated-orcid":false,"given":"Manvi","family":"Singh","sequence":"additional","affiliation":[{"name":"Indian Council of Medical Research Center for Evidence\u2010Based Child Health Postgraduate Institute of Medical Education and Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil","family":"Chauhan","sequence":"additional","affiliation":[{"name":"Indian Council of Medical Research Center for Evidence\u2010Based Child Health Postgraduate Institute of Medical Education and Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pranita","family":"Pradhan","sequence":"additional","affiliation":[{"name":"Indian Council of Medical Research Center for Evidence\u2010Based Child Health Postgraduate Institute of Medical Education and Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishant","family":"Jaiswal","sequence":"additional","affiliation":[{"name":"Indian Council of Medical Research Center for Evidence\u2010Based Child Health Postgraduate Institute of Medical Education and Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arunaloke","family":"Chakrabarti","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology Postgraduate Institute of Medical Education and Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meenu","family":"Singh","sequence":"additional","affiliation":[{"name":"Indian Council of Medical Research Center for Evidence\u2010Based Child Health Postgraduate Institute of Medical Education and Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,12,5]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/jof3040057"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(19)30349-8"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2014.01.024"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.4254\/wjh.v11.i7.596"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.23736\/S0375-9393.17.12034-1"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2017.471"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/mmy\/myab044"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.03.024"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.05.032"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz1008"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2020.100169"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2700"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-019-09946-3"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.02.042"},{"key":"e_1_2_11_16_1","unstructured":"Diagnostic and treatment guidelines for liver failure (2012 version). 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