Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Department of Critical Care Medicine, Beijing Jishuitan Hospital, Beijing, China.
Front Cell Infect Microbiol. 2022 Apr 27;12:829066. doi: 10.3389/fcimb.2022.829066. eCollection 2022.
To develop and validate a rapid invasive candidiasis (IC)-predictive risk score in intensive care unit (ICU) patients by incorporating clinical risk factors and parameters of lymphocyte subtyping.
A prospective cohort study of 1054 consecutive patients admitted to ICU was performed. We assessed the clinical characteristics and parameters of lymphocyte subtyping at the onset of clinical signs of infection and their potential influence on IC diagnosis. A risk score for early diagnosis of IC was developed and validated based on a logistic regression model.
Sixty-nine patients (6.5%) had IC. Patients in the cohort (N=1054) were randomly divided into a development (n=703) or validation (n=351) cohorts. Multivariate logistic regression identified that CD8+ T-cell count ≤143 cells/mm, receipt of high-dose corticosteroids (dose ≥50 mg prednisolone equivalent), receipt of carbapenem/tigecycline, APACHE II score≥15, (1,3)-β-D-glucan (BDG) positivity and emergency gastrointestinal/hepatobiliary (GIT/HPB) surgery were significantly related with IC. IC risk score was calculated using the following formula: CD8+ T-cell count ≤143 cells/mm + receipt of high-dose corticosteroids + receipt of carbapenem/tigecycline + APACHE II score ≥15 + BDG positivity + emergency GIT/HPB surgery ×2. The risk scoring system had good discrimination and calibration with area under the receiver operating characteristic (AUROC) curve of 0.820 and 0.807, and a non-significant Hosmer-Lemeshow test P=0.356 and P=0.531 in the development and validation cohorts, respectively. We categorized patients into three groups according to risk score: low risk (0-2 points), moderate risk (3-4 points) and high risk (5-7 points). IC risk was highly and positively associated with risk score (Pearson contingency coefficient=0.852, P for trend=0.007). Candida score had a moderate predicting efficacy for early IC diagnosis. The AUROC of the risk score was significantly larger than that of Candida score (0.820 versus 0.711, Z=2.013, P=0.044).
The predictive scoring system, which used both clinical factors and CD8+ T cell count, served as a clinically useful predictive model for rapid IC diagnosis in this cohort of ICU patients.
chictr.org.cn, identifier ChiCTR-ROC-17010750.
通过纳入临床危险因素和淋巴细胞亚群参数，开发并验证 ICU 患者侵袭性念珠菌病（IC）的快速预测风险评分。
对 1054 例连续入住 ICU 的患者进行前瞻性队列研究。我们在出现感染临床体征时评估临床特征和淋巴细胞亚群参数，并评估其对 IC 诊断的潜在影响。基于逻辑回归模型，开发并验证用于早期诊断 IC 的风险评分。
69 例（6.5%）患者发生 IC。该队列中的患者（n=1054）被随机分为开发（n=703）或验证（n=351）队列。多变量逻辑回归确定 CD8+T 细胞计数≤143 个细胞/mm³、接受高剂量皮质类固醇（剂量≥50mg 泼尼松龙等效物）、接受碳青霉烯/替加环素、APACHE II 评分≥15、（1,3）-β-D-葡聚糖（BDG）阳性和紧急胃肠/肝胆（GIT/HPB）手术与 IC 显著相关。IC 风险评分采用以下公式计算：CD8+T 细胞计数≤143 个细胞/mm³+接受高剂量皮质类固醇+接受碳青霉烯/替加环素+APACHE II 评分≥15+BDG 阳性+紧急 GIT/HPB 手术×2。风险评分系统具有良好的区分度和校准度，开发和验证队列的受试者工作特征曲线下面积（AUROC）分别为 0.820 和 0.807，Hosmer-Lemeshow 检验无显著差异（P=0.356 和 P=0.531）。根据风险评分，我们将患者分为三组：低危（0-2 分）、中危（3-4 分）和高危（5-7 分）。IC 风险与风险评分高度正相关（Pearson 列联系数=0.852，趋势检验 P=0.007）。念珠菌评分对早期 IC 诊断具有中等预测效果。风险评分的 AUROC 显著大于念珠菌评分（0.820 比 0.711，Z=2.013，P=0.044）。
该预测评分系统同时使用临床因素和 CD8+T 细胞计数，可为 ICU 患者的快速 IC 诊断提供一种有临床应用价值的预测模型。
chictr.org.cn，标识符 ChiCTR-ROC-17010750。
