Invasive fungal infections pose a severe threat in unconventional immunocompromised hosts such as cirrhosis. Herein we review the impact of invasive aspergillosis (IA) on the prognosis of cirrhosis patients. An electronic search for full-text articles describing IA in cirrhosis was conducted and the disease outcomes and mortality (point-estimate and comparative risk) were pooled on random-effects meta-analysis. Of 4127 articles, 11 studies (9 with good/fair and 2 with poor quality) were included. IA was associated with high disease severity and multi-organ failures in cirrhosis. The pooled-mortality of IA was 81.8% (95% CI: 64.3–91.8, I2 = 59%, P < 0.01). Estimate's-heterogeneity (I2) was explored through sub-groups, meta-regression, and influential diagnostics. Mortality estimates were higher among subgroups of acute-on-chronic liver failure (ACLF, 86.4%) and intensive care unit (ICU)-admitted patients (84.0%). The odds of mortality related to IA were 8.9 times higher than controls and much higher in ACLF (OR: 22.5) and ICU-admitted patients (OR: 36.4). The odds of mortality in IA were 4.1, 12.9, and 48.6 times higher than bacterial, no-fungal infections, and no-infection controls. There was no asymmetry in mortality estimates or odds ratios and mortality in IA was high irrespective of country of origin, site of infection, proven or probable category, and quality of study. Thus, IA is associated with very high mortality in cirrhosis patients, especially in ACLF and ICU-admitted patients. Intensive research is needed for the rapid diagnosis and treatment of IA in cirrhosis. Lay summary We report a high mortality rate of 81.8% in patients with liver cirrhosis and invasive aspergillosis. Higher odds (8.9 times) of death, especially in patients with ACLF or ICU admission were seen. Mortality was not affected by the country of study, site of infection, proven or probable nature of infection category, and quality of study.

中文翻译：

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侵袭性曲霉病是肝硬化死亡率的关键决定因素：荟萃分析的系统评价

侵袭性真菌感染对非常规免疫功能低下的宿主（如肝硬化）构成严重威胁。在此，我们回顾了侵袭性曲霉病 (IA) 对肝硬化患者预后的影响。对描述肝硬化 IA 的全文文章进行了电子搜索，并在随机效应荟萃分析中汇总了疾病结果和死亡率（点估计和比较风险）。在 4127 篇文章中，纳入了 11 篇研究（9 篇为良好/​​一般，2 篇质量较差）。IA 与肝硬化的高疾病严重程度和多器官衰竭有关。IA 的综合死亡率为 81.8%（95% CI：64.3-91.8，I2 = 59%，P < 0.01）。通过亚组、元回归和有影响的诊断来探索估计的异质性 (I2)。慢加急性肝衰竭（ACLF，86.4%）和重症监护病房（ICU）入院患者（84.0%）的死亡率估计值较高。与 IA 相关的死亡率比对照组高 8.9 倍，在 ACLF（OR：22.5）和 ICU 入院患者（OR：36.4）中更高。IA 的死亡率比细菌、非真菌感染和非感染对照组高 4.1、12.9 和 48.6 倍。死亡率估计或优势比没有不对称性，IA 的死亡率很高，与原籍国、感染部位、已证实或可能的类别以及研究质量无关。因此，IA 与肝硬化患者的高死亡率相关，特别是在 ACLF 和入住 ICU 的患者中。需要对肝硬化 IA 的快速诊断和治疗进行深入研究。总结 我们报告肝硬化和侵袭性曲霉病患者的高死亡率为 81.8%。死亡的几率更高（8.9 倍），尤其是在 ACLF 或 ICU 入院的患者中。死亡率不受研究国家、感染部位、感染类别的已证实或可能性质以及研究质量的影响。