{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:03:31Z","timestamp":1780635811765,"version":"3.54.1"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Medizinische Fakult\u00e4t Heidelberg der Universit\u00e4t Heidelberg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background &amp; aims<\/jats:title>\n                    <jats:p>Invasive fungal infections (IFIs) are increasingly recognized as a severe and often underdiagnosed complication in critically ill patients with liver cirrhosis. Cirrhosis-associated immune dysfunction, and advanced disease stage contribute to an elevated risk, particularly in the intensive care unit (ICU). Despite their high mortality, data on the epidemiology and timing of IFIs in ICU-treated cirrhotic patients remain limited. We aimed to determine the prevalence, timing, and impact of IFIs on 30- and 90-day survival in this high-risk population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective single-center cohort study included 488 patients with liver cirrhosis who were admitted to ICU between January 2014 and December 2019. Patients were evaluated for the presence of IFIs during their hospital stay and stratified into Non-IFI (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009458) and IFI (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200930) groups. Comparative analyses were performed with a specific focus on invasive candidiasis and invasive pulmonary aspergillosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      IFI prevalence was 6.1%. Invasive candidiasis and invasive pulmonary aspergillosis were diagnosed in 46.7% and 53.3% of IFI cases, with a median onset of 14.5 (6.50\u201324.00) and 17.5 (7.75-36.00) days, respectively. IFI patients had significantly more advanced liver disease reflected by higher MELD (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) score and more severe ACLF (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009) and required significantly more invasive procedures such as dialysis (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) parenteral nutrition (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and mechanical ventilation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). In addition, bacterial infections at admission were more common in IFI patients. The occurrence of IFI was associated with significantly reduced 30- and 90-day survival, particularly in patients with ACLF.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings highlight the need for IFI surveillance in critically ill cirrhosis patients, particularly in those with ACLF and bacterial infections at admission.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-026-13709-5","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T07:52:58Z","timestamp":1780559578000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical characteristics and outcomes of invasive fungal infections in critically ill patients with liver cirrhosis"],"prefix":"10.1186","volume":"26","author":[{"given":"Jessica","family":"See\u00dfle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Pelivan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marietta","family":"Kirchner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Boxberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Michl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uta","family":"Merle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"13709_CR1","doi-asserted-by":"publisher","unstructured":"Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013;144:1426-37, 1437 e1-9. https:\/\/doi.org\/10.1053\/j.gastro.2013.02.042","DOI":"10.1053\/j.gastro.2013.02.042"},{"key":"13709_CR2","doi-asserted-by":"publisher","first-page":"1246","DOI":"10.1053\/j.gastro.2010.06.019","volume":"139","author":"V Arvaniti","year":"2010","unstructured":"Arvaniti V, D\u00b4Amico G, Fede G, Manousou P, Tsochatzis E, et al. Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis. Gastroenterology. 2010;139:1246\u201356. https:\/\/doi.org\/10.1053\/j.gastro.2010.06.019.","journal-title":"Gastroenterology"},{"key":"13709_CR3","doi-asserted-by":"publisher","unstructured":"Bajaj J, Reddy RK, Tandon P, Wong F, Kamath P, et al. Prediction of fungal infection development and their impact on survival using the NACSELD cohort, Am J Gastroenterol. 2018;113:556\u201363. https:\/\/doi.org\/10.1038\/ajg.2017.471","DOI":"10.1038\/ajg.2017.471"},{"key":"13709_CR4","doi-asserted-by":"publisher","unstructured":"Bajaj JS, O\u00b4Leary JG, Reddy KR, Wong F, Olson JC, et al. Second infections independently increase mortality in hospitalized patients with cirrhosis: the North American consortium for the study of end-stage liver disease (NACSELD) experience. Hepatology. 2012;56:2328\u201335. https:\/\/doi.org\/10.1002\/hep.27077","DOI":"10.1002\/hep.27077"},{"key":"13709_CR5","doi-asserted-by":"publisher","first-page":"1870","DOI":"10.1136\/gutjnl-2017-314240","volume":"67","author":"J Fernandez","year":"2018","unstructured":"Fernandez J, Acevedo J, Wiest R, Gustot T, Amoros A, et al. Bacterial and fungal infections in acute-on-chronic liver failure: prevalence, characteristics and impact on prognosis. Gut. 2018;67:1870\u201380. https:\/\/doi.org\/10.1136\/gutjnl-2017-314240.","journal-title":"Gut"},{"key":"13709_CR6","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1111\/myc.13387","volume":"65","author":"N Verma","year":"2022","unstructured":"Verma N, Singh S, Singh M, Chauhan M, Pradhan P, et al. Global epidemiological burden of fungal infections in cirrhosis patients: A systematic review with meta-analysis. Mycoses. 2022;65:266\u201384. https:\/\/doi.org\/10.1111\/myc.13387.","journal-title":"Mycoses"},{"key":"13709_CR7","doi-asserted-by":"publisher","unstructured":"Theocharidou E, Agarwal B, Jeffrey G, Jalan R, Harrison D, et al. Early invasive fungal infections and colonization in patients with cirrhosis admitted to the intensive care unit. Clin Microbiol Infect. 2016;22(189 e1\u2013189 e7). https:\/\/doi.org\/10.1016\/j.cmi.2015.10.020.","DOI":"10.1016\/j.cmi.2015.10.020"},{"issue":"6","key":"13709_CR8","doi-asserted-by":"publisher","first-page":"1367","DOI":"10.1093\/cid\/ciz1008","volume":"71","author":"JP Donnelly","year":"2020","unstructured":"Donnelly JP, Chen SC, Kaufmann CA, Steinbach WJ, Baddley JW, the Mycoses Study Group Education and Research Consortium. Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and. Clin Infect Dis. 2020;71(6):1367\u201376. https:\/\/doi.org\/10.1093\/cid\/ciz1008.","journal-title":"Clin Infect Dis"},{"issue":"2","key":"13709_CR9","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1038\/s41575-021-00520-7","volume":"19","author":"A Albillos","year":"2022","unstructured":"Albillos A, Martin-Mateos R, Van der Merwe S, Wiest R, Jalan R, \u00c1lvarez-Mon M. Cirrhosis-associated immune dysfunction. Nat Rev Gastroenterol Hepatol. 2022;19(2):112\u201334. https:\/\/doi.org\/10.1038\/s41575-021-00520-7.","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"13709_CR10","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1080\/21505594.2016.1141162","volume":"27","author":"M Bartoletti","year":"2021","unstructured":"Bartoletti M, Rinaldi M, Pasquini Z, Scudeller L, Piano S, et al. Risk factors for candidaemia in hospitalized patients with liver cirrhosis: a multicentre case-control-control study. Clin Microbiol Infect. 2021;27:276\u201382. https:\/\/doi.org\/10.1080\/21505594.2016.1141162.","journal-title":"Clin Microbiol Infect"},{"issue":"3","key":"13709_CR11","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1111\/liv.13981","volume":"39","author":"N Verma","year":"2019","unstructured":"Verma N, Singh S, Taneja S, Duseja A, Singh V, et al. 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All participants provided written informed consent prior to enrollment in the study. The study was conducted in accordance with the principles outlined in the Declaration of Helsinki of the World Medical Association.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethic approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1088"}}