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Abstract：
BACKGROUND: Gastrointestinal candidiasis is often neglected and potentially serious infection in cirrhosis patients. Therefore, we evaluated the prevalence, risk factors, and outcomes of esophageal candidiasis (EC) in cirrhotics and did a systematic review to summarize EC\'s available evidence in cirrhosis.
METHODS: Consecutive patients with cirrhosis posted for esophagogastroduodenoscopy (EGD) at a tertiary care institute were screened for EC (cases) between January 2019 and March 2020. EC was diagnosed on EGD findings and/or brush cytology. Controls (without EC) were recruited randomly, and EC\'s risk factors and outcomes were compared between cases and controls.Four electronic databases were searched for studies describing EC in cirrhosis. Prevalence estimates of EC were pooled on random-effects meta-analysis, and heterogeneity was assessed by I2. A checklist for prevalence studies was used to evaluate the risk of bias in studies.
RESULTS: EC was diagnosed in 100 of 2762 patients with cirrhosis (3.6%). Patients with EC had a higher model for end-stage liver disease (MELD) (12.4 vs. 11.2; P = 0.007), acute-on-chronic liver failure (ACLF) (26% vs. 10%; P = 0.003) and concomitant bacterial infections (24% vs. 7%; P = 0.001), as compared with controls. A multivariable model, including recent alcohol binge, hepatocellular carcinoma (HCC), upper gastrointestinal (UGI) bleed, ACLF, diabetes, and MELD, predicted EC\'s development in cirrhosis with excellent discrimination (C-index: 0.918). Six percent of cases developed the invasive disease and worsened with multiorgan failures, and four patients with EC died on follow-up.Of 236 articles identified, EC\'s pooled prevalence from 8 studies (all with low-risk of bias) was 2.1% (95% CI: 0.8-5.8). Risk factors and outcomes of EC in cirrhosis were not reported in the literature.
CONCLUSIONS: EC is not a rare infection in cirrhosis patients, and it may predispose to invasive candidiasis and untimely deaths. Alcohol binge, HCC, UGI bleed, ACLF, diabetes, and higher MELD are the independent predictors of EC in cirrhosis. At-risk patients with cirrhosis or those with deglutition symptoms should be rapidly screened and treated for EC.
METHODS: Consecutive patients with cirrhosis posted for esophagogastroduodenoscopy (EGD) at a tertiary care institute were screened for EC (cases) between January 2019 and March 2020. EC was diagnosed on EGD findings and/or brush cytology. Controls (without EC) were recruited randomly, and EC\'s risk factors and outcomes were compared between cases and controls.Four electronic databases were searched for studies describing EC in cirrhosis. Prevalence estimates of EC were pooled on random-effects meta-analysis, and heterogeneity was assessed by I2. A checklist for prevalence studies was used to evaluate the risk of bias in studies.
RESULTS: EC was diagnosed in 100 of 2762 patients with cirrhosis (3.6%). Patients with EC had a higher model for end-stage liver disease (MELD) (12.4 vs. 11.2; P = 0.007), acute-on-chronic liver failure (ACLF) (26% vs. 10%; P = 0.003) and concomitant bacterial infections (24% vs. 7%; P = 0.001), as compared with controls. A multivariable model, including recent alcohol binge, hepatocellular carcinoma (HCC), upper gastrointestinal (UGI) bleed, ACLF, diabetes, and MELD, predicted EC\'s development in cirrhosis with excellent discrimination (C-index: 0.918). Six percent of cases developed the invasive disease and worsened with multiorgan failures, and four patients with EC died on follow-up.Of 236 articles identified, EC\'s pooled prevalence from 8 studies (all with low-risk of bias) was 2.1% (95% CI: 0.8-5.8). Risk factors and outcomes of EC in cirrhosis were not reported in the literature.
CONCLUSIONS: EC is not a rare infection in cirrhosis patients, and it may predispose to invasive candidiasis and untimely deaths. Alcohol binge, HCC, UGI bleed, ACLF, diabetes, and higher MELD are the independent predictors of EC in cirrhosis. At-risk patients with cirrhosis or those with deglutition symptoms should be rapidly screened and treated for EC.
摘要：
背景：在肝硬化患者中，胃肠道念珠菌病通常被忽视，并且可能是严重的感染。因此,我们评估了患病率，危险因素，和肝硬化食管念珠菌病（EC）的结果，并进行了系统评价，以总结EC在肝硬化中的可用证据。
方法：在2019年1月至2020年3月期间，在三级护理机构连续接受食管胃十二指肠镜检查（EGD）的肝硬化患者进行了EC（病例）筛查。根据EGD发现和/或刷子细胞学诊断出EC。对照组（无EC）随机招募，在病例和对照组之间比较EC的危险因素和结局。搜索了四个电子数据库，以进行描述肝硬化中EC的研究。在随机效应荟萃分析中汇总了EC的患病率估计值，异质性通过I2进行评估。使用患病率研究清单来评估研究中的偏倚风险。
结果：在2762例肝硬化患者中有100例（3.6％）被诊断为EC。EC患者的终末期肝病模型（MELD）较高（12.4vs.11.2；P=0.007），慢性急性肝衰竭(ACLF)(26%vs.10%；P=0.003）和伴随的细菌感染（24%vs.7%；P=0.001），与对照组相比。多变量模型,包括最近的酗酒,肝细胞癌（HCC），上消化道（UGI）出血，ACLF,糖尿病,MELD,预测肝硬化中EC的发展具有出色的辨别能力（C指数：0.918）。6%的病例发展为侵袭性疾病，并伴有多器官衰竭，4例EC患者在随访中死亡。在确定的236篇文章中，来自8项研究（均具有低偏倚风险）的EC合并患病率为2.1％（95％CI：0.8-5.8）。肝硬化的危险因素和结果未在文献中报道。
结论：EC不是肝硬化患者的罕见感染，它可能易患侵袭性念珠菌病和过早死亡。酗酒，HCC,UGI出血,ACLF,糖尿病,较高的MELD是肝硬化中EC的独立预测因子。有肝硬化或有吞咽症状的高危患者应迅速筛查并治疗EC。
方法：在2019年1月至2020年3月期间，在三级护理机构连续接受食管胃十二指肠镜检查（EGD）的肝硬化患者进行了EC（病例）筛查。根据EGD发现和/或刷子细胞学诊断出EC。对照组（无EC）随机招募，在病例和对照组之间比较EC的危险因素和结局。搜索了四个电子数据库，以进行描述肝硬化中EC的研究。在随机效应荟萃分析中汇总了EC的患病率估计值，异质性通过I2进行评估。使用患病率研究清单来评估研究中的偏倚风险。
结果：在2762例肝硬化患者中有100例（3.6％）被诊断为EC。EC患者的终末期肝病模型（MELD）较高（12.4vs.11.2；P=0.007），慢性急性肝衰竭(ACLF)(26%vs.10%；P=0.003）和伴随的细菌感染（24%vs.7%；P=0.001），与对照组相比。多变量模型,包括最近的酗酒,肝细胞癌（HCC），上消化道（UGI）出血，ACLF,糖尿病,MELD,预测肝硬化中EC的发展具有出色的辨别能力（C指数：0.918）。6%的病例发展为侵袭性疾病，并伴有多器官衰竭，4例EC患者在随访中死亡。在确定的236篇文章中，来自8项研究（均具有低偏倚风险）的EC合并患病率为2.1％（95％CI：0.8-5.8）。肝硬化的危险因素和结果未在文献中报道。
结论：EC不是肝硬化患者的罕见感染，它可能易患侵袭性念珠菌病和过早死亡。酗酒，HCC,UGI出血,ACLF,糖尿病,较高的MELD是肝硬化中EC的独立预测因子。有肝硬化或有吞咽症状的高危患者应迅速筛查并治疗EC。
