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Abstract：
BACKGROUND: Spontaneous fungal peritonitis (SFP) and fungiascites is less well-recognized and described in patients with liver cirrhosis. The aims of this study were to determine the clinical characteristics, prognosis, and risk factors of cirrhotic patients with SFP/fungiascites and to improve early differential diagnosis with spontaneous bacterial peritonitis (SBP).
METHODS: This was a retrospective case-control study of 54 cases of spontaneous peritonitis in cirrhotic patients (52 SFP and 2 fungiascites) with fungus-positive ascitic culture. Fifty-four SBP cirrhotic patients with bacteria-positive ascitic culture were randomly enrolled as a control group. A nomogram was developed for the early differential diagnosis of SFP and fungiascites.
RESULTS: Hospital-acquired infection was the main cause of SFP/fungiascites. Of the 54 SFP/fungiascites patients, 31 (57.41%) patients carried on with the antifungal treatment, which seemed to improve short-term (30-days) mortality but not long-term mortality. Septic shock and HCC were independent predictors of high 30-day mortality in SFP/fungiascites patients. We constructed a predictive nomogram model that included AKI/HRS, fever, (1,3)-β-D-glucan, and hospital-acquired infection markers for early differential diagnosis of SFP/fungiascites in cirrhotic patients with ascites from SBP, and the diagnostic performance was favorable, with an AUC of 0.930 (95% CI: 0.874-0.985).
CONCLUSIONS: SFP/fungiascites was associated with high mortality. The nomogram established in this article is a useful tool for identifying SFP/fungiascites in SBP patients early. For patients with strongly suspected or confirmed SFP/fungiascites, timely antifungal therapy should be administered.
METHODS: This was a retrospective case-control study of 54 cases of spontaneous peritonitis in cirrhotic patients (52 SFP and 2 fungiascites) with fungus-positive ascitic culture. Fifty-four SBP cirrhotic patients with bacteria-positive ascitic culture were randomly enrolled as a control group. A nomogram was developed for the early differential diagnosis of SFP and fungiascites.
RESULTS: Hospital-acquired infection was the main cause of SFP/fungiascites. Of the 54 SFP/fungiascites patients, 31 (57.41%) patients carried on with the antifungal treatment, which seemed to improve short-term (30-days) mortality but not long-term mortality. Septic shock and HCC were independent predictors of high 30-day mortality in SFP/fungiascites patients. We constructed a predictive nomogram model that included AKI/HRS, fever, (1,3)-β-D-glucan, and hospital-acquired infection markers for early differential diagnosis of SFP/fungiascites in cirrhotic patients with ascites from SBP, and the diagnostic performance was favorable, with an AUC of 0.930 (95% CI: 0.874-0.985).
CONCLUSIONS: SFP/fungiascites was associated with high mortality. The nomogram established in this article is a useful tool for identifying SFP/fungiascites in SBP patients early. For patients with strongly suspected or confirmed SFP/fungiascites, timely antifungal therapy should be administered.
摘要：
背景：自发性真菌性腹膜炎（SFP）和肺腹水在肝硬化患者中的认识和描述较少。这项研究的目的是确定临床特征，预后,和肝硬化患者SFP/肺腹水的危险因素，并提高自发性细菌性腹膜炎（SBP）的早期鉴别诊断。
方法：这是一项回顾性病例对照研究，对54例肝硬化患者（52例SFP和2例真菌腹水）的自发性腹膜炎进行真菌阳性腹水培养。随机纳入54例腹水细菌培养阳性的SBP肝硬化患者作为对照组。建立了SFP和肺腹水的早期鉴别诊断的列线图。
结果：医院获得性感染是SFP/真菌腹水的主要原因。在54例SFP/肺腹水患者中，31例（57.41%）患者进行抗真菌治疗，这似乎可以改善短期（30天）死亡率，但不能改善长期死亡率。脓毒性休克和HCC是SFP/肺腹水患者高30天死亡率的独立预测因子。我们构建了一个包含AKI/HRS的预测列线图模型，发烧,(1,3)-β-D-葡聚糖,和医院获得性感染标记物，用于早期鉴别诊断肝硬化腹水患者的SFP/真菌腹水，诊断性能良好，AUC为0.930（95%CI：0.874-0.985）。
结论：SFP/肺腹水与高死亡率相关。本文建立的列线图是早期识别SBP患者SFP/肺腹水的有用工具。对于强烈怀疑或确诊为SFP/肺腹水的患者，应及时进行抗真菌治疗。
方法：这是一项回顾性病例对照研究，对54例肝硬化患者（52例SFP和2例真菌腹水）的自发性腹膜炎进行真菌阳性腹水培养。随机纳入54例腹水细菌培养阳性的SBP肝硬化患者作为对照组。建立了SFP和肺腹水的早期鉴别诊断的列线图。
结果：医院获得性感染是SFP/真菌腹水的主要原因。在54例SFP/肺腹水患者中，31例（57.41%）患者进行抗真菌治疗，这似乎可以改善短期（30天）死亡率，但不能改善长期死亡率。脓毒性休克和HCC是SFP/肺腹水患者高30天死亡率的独立预测因子。我们构建了一个包含AKI/HRS的预测列线图模型，发烧,(1,3)-β-D-葡聚糖,和医院获得性感染标记物，用于早期鉴别诊断肝硬化腹水患者的SFP/真菌腹水，诊断性能良好，AUC为0.930（95%CI：0.874-0.985）。
结论：SFP/肺腹水与高死亡率相关。本文建立的列线图是早期识别SBP患者SFP/肺腹水的有用工具。对于强烈怀疑或确诊为SFP/肺腹水的患者，应及时进行抗真菌治疗。
