Cirrhosis is an independent risk factor for candidemia in critically ill patients: A 6-year single-center observational study

Abstract

Background

Candidemia is a significant threat in intensive care units (ICUs), particularly for patients with cirrhosis, who appear to have a higher prevalence. No prior study has demonstrated cirrhosis as an independent risk factor for candidemia. This study aimed to investigate the risk factors and mortality associated with candidemia in ICUs, focusing on patients with cirrhosis.

Methods

We conducted a retrospective observational study over a 6-year period in an ICU with a high volume of patients with cirrhosis. We consecutively included 1985 patients, of whom 416 had cirrhosis. Among them, 37 developed candidemia, including 16 with cirrhosis. We analyzed the risk factors for candidemia in the total population and patients with cirrhosis.

Results

We identified cirrhosis as an independent risk factor for candidemia in the ICU (OR 2.28 [1.14–4.53], p = 0.019) in the total population admitted to the ICU. Among patients with cirrhosis, a high Child–Pugh score remained the sole independent correlate of candidemia (OR 1.68 [1.10–2.67]; p = 0.021). Post hoc acute on chronic liver failure (ACLF) analysis showed significantly lower candidemia-free survival in ACLF grade 2–3 versus 0–1 (log-rank, p = 0.029). Candidemia was associated with higher ICU mortality rates in both the total population (59.5%) and in patients with cirrhosis (81.2%).

Conclusion

Cirrhosis emerged as an independent risk factor for candidemia in the ICU. Within the cirrhotic subgroup, a high Child–Pugh score emerged as the sole independent correlate.