Strike Fast: Early Antifungal Treatment Boosts Liver Failure Survival

For patients battling acute-on-chronic liver failure (ACLF), invasive fungal infections (IFIs) are a silent and often fatal threat, frequently leading to transplant de-listings and high mortality. A recent pragmatic randomised trial has challenged the hesitation to treat these infections without concrete proof. The study compared two strategies: an 'empirical' approach, where doctors administer antifungals immediately upon suspicion, and a 'diagnostic' approach, which waits for laboratory, radiological, or mycological confirmation.

The results were decisive. Patients receiving immediate empirical therapy saw a 28-day survival rate of 35%, compared to just 13% for those who waited for diagnosis. Furthermore, this aggressive strategy resulted in significantly lower in-hospital mortality (55.6% vs 75.9%) and higher rates of infection resolution. The survival benefit was most pronounced in patients aged 40 or older experiencing cardiovascular failure. These findings suggest that in high-burden settings, time is the most critical factor; prioritising rapid intervention over diagnostic certainty can offer vulnerable patients a much stronger chance of recovery.