Gupta Priyanka, Gupta Pratima, Chatterjee Biswaroop, Mittal Garima, Prateek Shashank, Mohanty Aroop
Department of Microbiology, AIIMS, Rishikesh, Uttarakhand, India.
Department of Microbiology, Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun, Uttarakhand, India.
Indian J Crit Care Med. 2017 Dec;21(12):830-835. doi: 10.4103/ijccm.IJCCM_159_17.
Candidemia in critically ill patients is usually a severe and life-threatening condition. Furthermore, due to its nonspecific presentation, it is difficult to diagnose leading to delayed treatment, prolonged hospitalization, and increased health-care costs with increase in morbidity and mortality.
In view of lack of data on " scoring systems," this study was designed to evaluate the effectiveness of these scoring systems in predicting the development of candidemia among the Intensive Care Unit patients.
The " score" was calculated at the onset of systemic inflammatory response syndrome, sepsis, or shock. Various scoring systems were compared using the area under the receiver operating characteristic curve.
Among all three bedside risk scoring systems to predict candidemia both Leon score and Wenzel score offered significant discrimination between candidemic and noncandidemic patients with = 0.000 and 0.001, respectively. The area under the curve for the scoring systems was 0.946 (95% confidence interval [CI] = 0.89-1) and 0.818 (95% CI = 0.687-0.949).
Leon scoring system was found to have highest specificity, diagnostic accuracy, and positive likelihood ratio among all. Thus, we might conclude that a Leon score of ≥2.5 was most suitable for diagnosis of candidemia with significant accuracy and shortening of turnaround time when compared to the gold standard of blood culture. To the best of our knowledge, this is the first report on the subject.
危重症患者的念珠菌血症通常是一种严重的、危及生命的病症。此外，由于其临床表现不具特异性，难以诊断，从而导致治疗延误、住院时间延长、医疗费用增加，发病率和死亡率也随之上升。
鉴于缺乏关于“评分系统”的数据，本研究旨在评估这些评分系统在预测重症监护病房患者念珠菌血症发生方面的有效性。
在全身炎症反应综合征、脓毒症或休克发作时计算“评分”。使用受试者操作特征曲线下面积比较各种评分系统。
在所有三种用于预测念珠菌血症的床边风险评分系统中，Leon评分和Wenzel评分在念珠菌血症患者和非念珠菌血症患者之间均具有显著的区分能力，P值分别为0.000和0.001。这些评分系统的曲线下面积分别为0.946（95%置信区间[CI]=0.89 - 1）和0.818（95%CI = 0.687 - 0.949）。
发现Leon评分系统在所有系统中具有最高特异性、诊断准确性和阳性似然比。因此，我们可以得出结论，与血培养的金标准相比，Leon评分≥2.5最适合念珠菌血症的诊断，具有显著的准确性且能缩短周转时间。据我们所知，这是关于该主题的首篇报道。
