Division of Infectious Diseases, Kangdong Sacred Heart Hospital, Hallym University School of Medicine, 150 Seongan-ro, Gangdong-gu, Seoul, 134-701, Republic of Korea.
Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Seoul, South Korea.
BMC Infect Dis. 2020 Jun 5;20(1):396. doi: 10.1186/s12879-020-05117-0.
Delayed antifungal therapy for candidemia leads to increased mortality. Differentiating bacterial infection from candidemia in systemic inflammatory response syndrome (SIRS) patients is complex and difficult. The Delta Neutrophil Index (DNI) has recently been considered a new factor to distinguish infections from non-infections and predict the severity of sepsis. We aimed to assess if the DNI can predict and provide a prognosis for candidemia in SIRS patients.
A matched case-control study was conducted from July 2016 to June 2017 at Kangdong Sacred Heart Hospital. Among patients with a comorbidity of SIRS, those with candidemia were classified as the case group, whereas those with negative blood culture results were classified as the control group. The matching conditions included age, blood culture date, and SIRS onset location. Multivariate logistic regression was performed to evaluate DNI as a predictive and prognostic factor for candidemia.
The 140 included patients were assigned to each group in a 1:1 ratio. The DNI_D1 values measured on the blood culture date were higher in the case group than in the control group (p < 0.001). The results of multivariate analyses confirmed DNI_D1 (odds ratio [ORs] 2.138, 95% confidential interval [CI] 1.421-3.217, p < 0.001) and Candida colonization as predictive factors for candidemia. The cutoff value of DNI for predicting candidemia was 2.75%. The area under the curve for the DNI value was 0.804 (95% CI, 0.719-0.890, p < 0.001), with a sensitivity and specificity of 72.9 and 78.6%, respectively. Analysis of 14-day mortality in patients with candidemia showed significantly higher DNI_D1 and DNI_48 in the non-survivor group than in the survivor group.
DNI was identified as a predictive factor for candidemia in patients with SIRS and a prognostic factor in predicting 14-day mortality in candidemia patients. DNI, along with clinical patient characteristics, was useful in determining the occurrence of candidemia in patients with SIRS.
对于念珠菌血症，延迟抗真菌治疗会导致死亡率增加。在全身性炎症反应综合征（SIRS）患者中，区分细菌感染和念珠菌血症较为复杂和困难。Delta 中性粒细胞指数（DNI）最近被认为是区分感染和非感染以及预测脓毒症严重程度的新因素。我们旨在评估 DNI 是否可以预测和提供 SIRS 患者念珠菌血症的预后。
2016 年 7 月至 2017 年 6 月，我们在韩国东大门圣心医院进行了一项匹配病例对照研究。在患有 SIRS 合并症的患者中，将患有念珠菌血症的患者分为病例组，而将血培养结果为阴性的患者分为对照组。匹配条件包括年龄、血培养日期和 SIRS 发病部位。采用多变量逻辑回归评估 DNI 作为念珠菌血症的预测和预后因素。
共纳入 140 例患者，每组各 70 例。在病例组中，血培养日的 DNI_D1 值高于对照组（p<0.001）。多变量分析结果证实，DNI_D1（比值比[ORs]2.138，95%置信区间[CI]1.421-3.217，p<0.001）和念珠菌定植是念珠菌血症的预测因素。预测念珠菌血症的 DNI 截断值为 2.75%。DNI 值的曲线下面积为 0.804（95%CI，0.719-0.890，p<0.001），灵敏度和特异度分别为 72.9%和 78.6%。对念珠菌血症患者 14 天死亡率的分析显示，在非幸存者组中，DNI_D1 和 DNI_48 明显高于幸存者组。
DNI 被确定为 SIRS 患者念珠菌血症的预测因素，也是预测念珠菌血症患者 14 天死亡率的预后因素。DNI 与临床患者特征一起，有助于确定 SIRS 患者念珠菌血症的发生。
