Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
Infect Dis (Lond). 2021 Nov-Dec;53(12):908-919. doi: 10.1080/23744235.2021.1959052. Epub 2021 Jul 30.
This study aimed to investigate factors associated with septic shock development and 30-day mortality outcome with a prediction model among adult candidemia patients in the intensive care unit (ICU).
A retrospective study was conducted among patients admitted to the ICU from 2009 to 2018 at a tertiary care medical centre. The study subjects included adult patients ≥ 19 years with candidemia treated with antifungal agent for ≥ 3 days. Clinical variables were collected and analysed.
A total of 126 patients were included in the study. Of these patients, 32 patients (25.4%) had septic shock. Multivariate logistic regression analysis revealed that chronic liver disease was associated with septic shock (odds ratio [OR] 3.372, 95% confidence interval [CI] 1.057 - 10.057). The rate of 30-day mortality was 35.7% and the associated mortality risk factors were malignancy (OR 8.251, 95% CI 2.227 - 30.573), chronic liver disease (OR 3.605, 95% CI 0.913 - 14.227), haemodialysis (OR 8.479, 95% CI 1.801 - 39.924), mycological failure (OR 29.675, 95% CI 7.012 - 125.578), and septic shock (OR 3.980, 95% CI 1.238 - 12.796). A predictive model for 30-day mortality was created based on the mortality risk factor scores, which had an area of 0.862 under the receiver operating characteristic curve.
Adult candidemia patients in the ICU who have chronic liver disease may be at higher risk of developing septic shock. Furthermore, our predictive model for 30-day mortality based on the mortality risk factors may be useful for clinical assessment.
本研究旨在探讨重症监护病房（ICU）成人念珠菌血症患者发生感染性休克和 30 天死亡率的相关因素，并建立预测模型。
对 2009 年至 2018 年在一家三级医疗中心 ICU 住院的患者进行回顾性研究。研究对象包括接受抗真菌治疗≥3 天的≥19 岁成人念珠菌血症患者。收集并分析临床变量。
本研究共纳入 126 例患者。其中，32 例（25.4%）患者发生感染性休克。多变量 logistic 回归分析显示，慢性肝病与感染性休克有关（比值比 [OR] 3.372，95%置信区间 [CI] 1.057-10.057）。30 天死亡率为 35.7%，相关死亡危险因素包括恶性肿瘤（OR 8.251，95%CI 2.227-30.573）、慢性肝病（OR 3.605，95%CI 0.913-14.227）、血液透析（OR 8.479，95%CI 1.801-39.924）、真菌学失败（OR 29.675，95%CI 7.012-125.578）和感染性休克（OR 3.980，95%CI 1.238-12.796）。根据死亡风险因素评分创建了 30 天死亡率预测模型，ROC 曲线下面积为 0.862。
ICU 成人念珠菌血症患者中，患有慢性肝病的患者可能更容易发生感染性休克。此外，我们基于死亡风险因素建立的 30 天死亡率预测模型可能有助于临床评估。
