Invasive aspergillosis in patients with severe alcoholic hepatitis

Abstract

Background & aims: Severe alcoholic hepatitis (AH) has a poor short-term prognosis. Although infections are frequent complications of AH, the incidence of invasive aspergillosis (IA) and its impact on outcome remain unknown.

Methods: We prospectively followed 94 biopsy-proven severe AH episodes for 3 months. We retrospectively reviewed our diagnosis of IA based on EORTC/MSG and AspICU criteria, except for host factors.

Results: Fifteen IA (6 proven, 8 probable, and 1 possible) were diagnosed after a median delay of 26 days following diagnosis of AH. The sites of infection were the lungs (n=11) and central nervous system (n=2), while IA was disseminated in 2 cases. Baseline MELD score ≥24 and ICU admission were independent risk factors for IA. Thirteen IA occurred in the context of corticosteroids, and 2 had received no specific treatment for AH. Non-response to corticosteroids at day 7 was not a risk factor for IA, but IA was associated with absence of liver improvement at day 28. Despite antifungal treatment, 3-month transplant-free survival of patients with IA was 0% compared to 53% in those without IA. IA, Lille score ≥0.45, and overt encephalopathy were independent predictors of transplant-free mortality.

Conclusions: IA is a frequent complication of severe AH and carries a very high risk of mortality. Systematic screening for IA should be recommended in these patients. Further studies are needed to identify high-risk populations requiring antifungal prophylactic treatment.

Keywords: ABIC; AH; AUROC; Age, serum Bilirubin, INR, and serum Creatinine; Alcoholic hepatitis; Aspergillosis; BAL; CSF; CT; Corticosteroids; GM; IA; ICU; INR; Infection; LT; MELD; NPV; PPV; PT; SBP; alcoholic hepatitis; area under receiver operating characteristic curve; bronchoalveolar lavage; cerebrospinal fluid; computed tomography; galactomannan; intensive care unit; international normalized ratio; invasive aspergillosis; liver transplantation; mDF; model for end-stage liver disease; modified discriminant function; negative predictive value; positive predictive value; prothrombin time; spontaneous bacterial peritonitis.