title: Fungal "colonisation" is associated with increased mortality in medical intensive care unit patients with liver cirrhosis.
abstract: OBJECTIVE
  Patients with liver cirrhosis are at increased risk for fungal infections. However, distinction of fungal colonisation (FC) and invasive mycoses is difficult. Aim of this study was to analyse the impact of FC on mortality of cirrhotic ICU-patients.
  
  
  METHODS
  Retrospective mortality analysis of a prospectively maintained database on 120 cirrhotic patients with and without FC. Comparison to 120 noncirrhotic controls matched for APACHE-II (24.9 ± 3.7 vs. 25.0 ± 2.6; p = 0.263).
  
  
  RESULTS
  About 69/120 (58%) of patients with cirrhosis had FC. These patients had significantly higher APACHE-II score and mortality compared to cirrhotic patients without FC (27 ± 3 vs. 23 ± 4, p < 0.001; 78 vs. 35%, p < 0.001). In multivariate analysis, FC was independently (p = 0.047) associated to mortality. Mortality of noncirrhotic patients with FC (14/31; 45.2%) was not different to noncirrhotic controls without FC [28/89 (31.2%; p = 0.168)]. Similarly, in multivariate analysis of noncirrhotics, APACHE-II (p < 0.001), but not FC, was independently associated to mortality. Multiple regression analysis of all 240 cirrhotic and noncirrhotic patients demonstrated that APACHE-II (p < 0.001), cirrhosis (p = 0.001) and FC (p = 0.049) were independently associated with mortality.
  
  
  CONCLUSIONS
  Fungal "colonisation" is independently associated to mortality in cirrhotic ICU-patients. Early antimycotic therapy should be considered in critically ill cirrhotic patients with FC.
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, Munich, Germany, Tobias.Lahmer@lrz.tu-muenchen.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Lahmer
authors.forename: Marlena
authors.initials: M
authors.lastname: Messer
authors.forename: Ulrich
authors.initials: U
authors.lastname: Mayr
authors.forename: Bernd
authors.initials: B
authors.lastname: Saugel
authors.forename: Sebastian
authors.initials: S
authors.lastname: Noe
authors.forename: Caroline
authors.initials: C
authors.lastname: Schultheiss
authors.forename: Philipp
authors.initials: P
authors.lastname: Thies
authors.forename: Christoph
authors.initials: C
authors.lastname: Spinner
authors.forename: Simon
authors.initials: S
authors.lastname: Nennstiel
authors.forename: Christiane
authors.initials: C
authors.lastname: Schwerdtfeger
authors.forename: Veit
authors.initials: V
authors.lastname: Phillip
authors.forename: Roland M
authors.initials: RM
authors.lastname: Schmid
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Huber
mesh_terms: D018806:APACHE; D002175:Candida / Q000302:isolation & purification / Q000472:pathogenicity*; D016638:Critical Illness / Q000401:mortality; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008099:Liver / Q000382:microbiology / Q000473:pathology; D008103:Liver Cirrhosis / Q000382:microbiology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications / Q000382:microbiology / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index