Department of Clinical Infectious Diseases, Aichi Medical University Hospital, 480-1195 1-1 Yazakokarimata, Nagakute, Aichi, Japan.
Department of Infection Control and Prevention, Aichi Medical University Hospital, Nagakute, Japan.
BMC Infect Dis. 2021 Jan 15;21(1):77. doi: 10.1186/s12879-020-05719-8.
Candidemia has emerged as an important nosocomial infection, with a mortality rate of 30-50%. It is the fourth most common nosocomial bloodstream infection (BSI) in the United States and the seventh most common nosocomial BSI in Europe and Japan. The aim of this study was to assess the performance of the Sequential Organ Failure Assessment (SOFA) score for determining the severity and prognosis of candidemia.
We performed a retrospective study of patients admitted to hospital with candidemia between September 2014 and May 2018. The severity of candidemia was evaluated using the SOFA score and the Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) score. Patients' underlying diseases were assessed by the Charlson Comorbidity Index (CCI).
Of 70 patients enrolled, 41 (59%) were males, and 29 (41%) were females. Their median age was 73 years (range: 36-93 years). The most common infection site was catheter-related bloodstream infection (n=36, 51%).The 30-day, and in-hospital mortality rates were 36 and 43%, respectively. Univariate analysis showed that SOFA score ≥5, APACHE II score ≥13, initial antifungal treatment with echinocandin, albumin < 2.3, C-reactive protein > 6, disturbance of consciousness, and CCI ≥3 were related with 30-day mortality. Of these 7, multivariate analysis showed that the combination of SOFA score ≥5 and CCI ≥3 was the best independent prognostic indicator for 30-day and in-hospital mortality.
The combined SOFA score and CCI was a better predictor of the 30-day mortality and in-hospital mortality than the APACHE II score alone.
念珠菌血症已成为一种重要的医院获得性感染，死亡率为 30-50%。它是美国第四种常见的医院获得性血流感染（BSI），也是欧洲和日本第七种常见的医院获得性 BSI。本研究旨在评估序贯器官衰竭评估（SOFA）评分对确定念珠菌血症严重程度和预后的作用。
我们对 2014 年 9 月至 2018 年 5 月期间因念珠菌血症住院的患者进行了回顾性研究。使用 SOFA 评分和急性生理学、年龄、慢性健康评估 II（APACHE II）评分评估念珠菌血症的严重程度。通过 Charlson 合并症指数（CCI）评估患者的基础疾病。
在纳入的 70 名患者中，41 名（59%）为男性，29 名（41%）为女性。他们的中位年龄为 73 岁（范围：36-93 岁）。最常见的感染部位是导管相关血流感染（n=36，51%）。30 天和住院死亡率分别为 36%和 43%。单因素分析显示，SOFA 评分≥5、APACHE II 评分≥13、初始抗真菌治疗使用棘白菌素、白蛋白<2.3、C-反应蛋白>6、意识障碍和 CCI≥3 与 30 天死亡率相关。在这 7 个因素中，多因素分析显示，SOFA 评分≥5 和 CCI≥3 的组合是 30 天和住院死亡率的最佳独立预后指标。
与单独的 APACHE II 评分相比，SOFA 评分和 CCI 的组合是预测 30 天死亡率和住院死亡率的更好指标。
