The importance of infections in cirrhosis

In patients with cirrhosis, or liver scarring, infections are associated with poor outcomes and a very high death rate, report researchers at MUSC's Digestive Disease Research Center (DDRC) in The American Journal of Medical Sciences. Their findings also raise the possibility that physicians may not be treating these patients for the right types of infections.

The MUSC research team, led by DDRC director Don Rockey, M.D., reviewed the medical records of 877 patients who were hospitalized with cirrhosis. The study found that 20% of the patients died from infections, and that about 12% of all infections came from fungal organisms.

“There are serious infections lurking in patients with cirrhosis. It’s not until the patient is spiraling downward and doing poorly that doctors think about these fungal infections." -- Dr. Don Rockey

Every 24 hours, the liver filters approximately 45 gallons of blood, which is full of nutrients but also contains bacteria, fungi and other compounds. In the healthy liver, specialized cells known as Kupffer cells remove harmful bacteria and/or fungi.  However, when the liver becomes cirrhotic, or scarred, Kupffer cells don’t function normally, said Rockey, leaving patients at increased risk for infection.

Prior to the MUSC study, fungal infections were thought to be uncommon in patients with cirrhosis. The high frequency of fungal infections found in the study has implications for patient care.

“Doctors caring for these patients don’t routinely think about fungal infections” said Rockey.

 

Since doctors may not anticipate seeing fungal infections in their patients, they tend to treat for other types of infections first. Fungal infections are resistant to typical antibiotics that are prescribed for bacterial infections. As a result, by the time doctors begin to suspect a fungal infection, it is often too late for effective treatment.

“There are serious infections lurking in patients with cirrhosis,” said Rockey. “It’s not until the patient is spiraling downward and doing poorly that doctors think about these fungal infections. Thus, the findings from this study emphasize how important it is for doctors to think about these organisms early.”

Rockey believes it is also important to inform patients with cirrhosis that infections can be deadly.

“Sadly, the average patient with cirrhosis does not understand that they are immunocompromised, which means they are less able to fight infections,” said Rockey.

Rockey emphasized that patients with cirrhosis need to be proactive when it comes to infection.

“If patients with cirrhosis think they have an infection or aren’t doing well – no matter the reason – they need to get to their doctor or to an emergency room promptly,” said Rockey. “Infections are the leading cause of death right now for patients with cirrhosis.”

Reference

Choudry N, Sasso R, Rockey DC. Infection in Hospitalized Cirrhosis Patients: Changing Epidemiology and Clinical Features. Am J Med Sci. 2022 Jan 4:S0002-9629(21)00449-3. doi: 10.1016/j.amjms.2021.10.023. Epub ahead of print. PMID: 34995572.