Verma N, Singh S, Singh M, et al. - The epidemiology and trends of fungal infections (FIs) were investigated among patients with cirrhosis.

• Searching four electronic-databases, researchers identified 34 low-risk and four moderate-risk studies (31,984 patients with cirrhosis) for inclusion.

• Overall findings suggest that a substantial burden is imposed by FIs in cirrhosis.

• In cirrhosis, following were the pooled-estimates of overall-FIs (17 studies), invasive fungal infections (IFIs; 17 studies), invasive-candidiasis (23 studies), and invasive-aspergillosis (16 studies): 10.2%(6.0-16.9), 9.5%(5.4-16.2), 4.0%(2.0-8.0) and 2.8%(1.5-5.3); respectively.

• In decreasing order of pooled-prevalence, FIs affected the following sites: pulmonary, urinary-tract, bloodstream, peritoneal, esophageal, and cerebral.

• There were remarkable geographic differences in these estimates, with Belgium, USA, and India exhibiting the highest burden of overall-FIs.

• Over the last-decade, there appeared an increase in non-albicans-Candida and Aspergillus infections in cirrhosis.

• The highest prevalence of IFIs was recorded in intensive-care-unit (ICU)-admitted and acute-on-chronic liver failure (ACLF) patients.

• Following were the predictors of variance in overall-FI-estimates: MELD-score(cases), bias-score, and sample size across studies.

• In patients with FIs, the common predispositions were diabetes, steroid and broad-spectrum antibiotic-exposure, and multiple organ failures.