Gaspar Gilberto Gambero, Menegueti Mayra Gonçalves, Auxiliadora-Martins Maria, Basile-Filho Anibal, Martinez Roberto
Departamento de Medicina Interna, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
Comissão de Controle de Infeccção Hospitalar, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
Rev Soc Bras Med Trop. 2015 Jan-Feb;48(1):77-82. doi: 10.1590/0037-8682-0292-2014. Epub 2015 Jan 1.
To evaluate predictive indices for candidemia in an adult intensive care unit (ICU) and to propose a new index.
A prospective cohort study was conducted between January 2011 and December 2012. This study was performed in an ICU in a tertiary care hospital at a public university and included 114 patients staying in the adult ICU for at least 48 hours. The association of patient variables with candidemia was analyzed.
There were 18 (15.8%) proven cases of candidemia and 96 (84.2%) cases without candidemia. Univariate analysis revealed the following risk factors: parenteral nutrition, severe sepsis, surgical procedure, dialysis, pancreatitis, acute renal failure, and an APACHE II score higher than 20. For the Candida score index, the odds ratio was 8.50 (95% CI, 2.57 to 28.09); the sensitivity, specificity, positive predictive value, and negative predictive value were 0.78, 0.71, 0.33, and 0.94, respectively. With respect to the clinical predictor index, the odds ratio was 9.45 (95%CI, 2.06 to 43.39); the sensitivity, specificity, positive predictive value, and negative predictive value were 0.89, 0.54, 0.27, and 0.96, respectively. The proposed candidemia index cutoff was 8.5; the sensitivity, specificity, positive predictive value, and negative predictive value were 0.77, 0.70, 0.33, and 0.94, respectively.
The Candida score and clinical predictor index excluded candidemia satisfactorily. The effectiveness of the candidemia index was comparable to that of the Candida score.
评估成人重症监护病房（ICU）念珠菌血症的预测指标并提出一个新指标。
2011年1月至2012年12月进行了一项前瞻性队列研究。该研究在一所公立大学的三级护理医院的ICU进行，纳入了114名在成人ICU至少停留48小时的患者。分析了患者变量与念珠菌血症的关联。
有18例（15.8%）确诊念珠菌血症病例，96例（84.2%）无念珠菌血症病例。单因素分析显示以下危险因素：肠外营养、严重脓毒症、手术、透析、胰腺炎、急性肾衰竭以及急性生理与慢性健康状况评分系统（APACHE II）评分高于20。对于念珠菌评分指数，比值比为8.50（95%置信区间，2.57至28.09）；敏感性、特异性、阳性预测值和阴性预测值分别为0.78、0.71、0.33和0.94。关于临床预测指标，比值比为9.45（95%置信区间，2.06至43.39）；敏感性、特异性、阳性预测值和阴性预测值分别为0.89、0.54、0.27和0.96。所提出的念珠菌血症指数临界值为8.5；敏感性、特异性、阳性预测值和阴性预测值分别为0.77、0.70、0.33和0.94。
念珠菌评分和临床预测指标能令人满意地排除念珠菌血症。念珠菌血症指数的有效性与念珠菌评分相当。
