EQUAL 念珠菌评分预测念珠菌血症患者结局的有效性：一项回顾性队列研究。

Usefulness of EQUAL Candida Score for predicting outcomes in patients with candidaemia: a retrospective cohort study.

机构信息

Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.

Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.

出版信息

Clin Microbiol Infect. 2020 Nov;26(11):1501-1506. doi: 10.1016/j.cmi.2020.01.029. Epub 2020 Feb 6.

DOI:10.1016/j.cmi.2020.01.029

PMID:32036049

Abstract

BACKGROUND

The European Confederation of Medical Mycology (ECMM) Quality of Clinical Candidaemia Management (EQUAL) score is a tool designed by the ECMM to measure guideline adherence. The current study investigated the association between EQUAL scores and clinical outcomes.

METHODS

This retrospective study was conducted in three hospitals in Taiwan. Patients with candidaemia between January 2014 and July 2018 were enrolled. Guideline adherence was evaluated using EQUAL score indicators. Clinical outcomes and predictors of 30-day mortality were investigated.

RESULTS

A total of 384 patients were enrolled. The overall mean EQUAL score was 8.91 ± 3.42 (9.42 ± 3.60 in survivors vs. 8.10 ± 2.94 in non-survivors, p < 0.001). Higher scores were positively correlated with survival (p < 0.001). Scores of 16-22 indicated the highest survival rates (p for trend <0.001). The Kaplan-Meier plot revealed that patients with EQUAL scores ≥10 exhibited significantly higher survival rates (p < 0.001) than those with scores <10. Multivariable analysis revealed that EQUAL scores ≥10 (odds ratio (OR) 0.37, 95% confidence interval (CI) 0.19-0.74), advanced age (OR 1.02, 95% CI 1.00-1.04), septic shock (OR 4.42, 95% CI 2.09-9.36), high sequential organ failure assessment scores (OR 4.28, 95% CI 2.15-8.52), intravascular catheter-related source (OR 0.42, 95% CI 0.19-0.94) and central venous catheter retention (OR 5.41, 95% CI 2.06-14.24) were independent predictors of 30-day mortality.

DISCUSSION

Greater guideline adherence with a higher EQUAL score was significantly associated with survival. An EQUAL score cutoff point <10 predicted 30-day mortality.

摘要

背景

欧洲医学真菌联合会（ECMM）制定的临床念珠菌血症管理质量（EQUAL）评分是一种衡量指南依从性的工具。本研究旨在探讨 EQUAL 评分与临床结局之间的关系。

方法

本回顾性研究纳入了 2014 年 1 月至 2018 年 7 月在台湾三家医院确诊为念珠菌血症的患者。采用 EQUAL 评分指标评估指南依从性。分析了 30 天死亡率的临床结局和预测因素。

结果

共纳入 384 例患者。总的来说，EQUAL 评分平均为 8.91±3.42（存活者为 9.42±3.60，非存活者为 8.10±2.94，p＜0.001）。较高的评分与生存率呈正相关（p＜0.001）。评分在 16-22 分之间的患者生存率最高（p＜0.001）。Kaplan-Meier 图显示，EQUAL 评分≥10 分的患者生存率明显高于评分＜10 分的患者（p＜0.001）。多变量分析显示，EQUAL 评分≥10 分（比值比（OR）0.37，95%置信区间（CI）0.19-0.74）、年龄较大（OR 1.02，95%CI 1.00-1.04）、感染性休克（OR 4.42，95%CI 2.09-9.36）、序贯器官衰竭评估评分较高（OR 4.28，95%CI 2.15-8.52）、血管内导管相关源（OR 0.42，95%CI 0.19-0.94）和中心静脉导管保留（OR 5.41，95%CI 2.06-14.24）是 30 天死亡率的独立预测因素。