Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China.
Department of Medical Oncology, Baoji Traditional Chinese Medicine Hospital, No.43 Baofu Road, Baoji, Shaanxi, 721001, People's Republic of China.
BMC Infect Dis. 2023 Jul 17;23(1):472. doi: 10.1186/s12879-023-08447-x.
Patients with malignancy are at a higher risk of developing nosocomial infections. However, limited studies investigated the clinical features and prognostic factors of nosocomial infections due to fungi in cancer patients. Herein, this study aims to investigate the clinical characteristics of in-hospital fungal infections and develop a nomogram to predict the risk of in-hospital death during fungal infection of hospitalized cancer patients.
This retrospective observational study enrolled cancer patients who experienced in-hospital fungal infections between September 2013 and September 2021. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of in-hospital mortality. Variables demonstrating significant statistical differences in the multivariate analysis were utilized to construct a nomogram for personalized prediction of in-hospital death risk associated with nosocomial fungal infections. The predictive performance of the nomogram was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis.
A total of 216 participants were included in the study, of which 57 experienced in-hospital death. C.albicans was identified as the most prevalent fungal species (68.0%). Respiratory infection accounted for the highest proportion of fungal infections (59.0%), followed by intra-abdominal infection (8.8%). The multivariate regression analysis revealed that Eastern Cooperative Oncology Group Performance Status (ECOG-PS) 3-4 (odds ratio [OR] = 6.08, 95% confidence interval [CI]: 2.04-18.12), pulmonary metastases (OR = 2.76, 95%CI: 1.11-6.85), thrombocytopenia (OR = 2.58, 95%CI: 1.21-5.47), hypoalbuminemia (OR = 2.44, 95%CI: 1.22-4.90), and mechanical ventilation (OR = 2.64, 95%CI: 1.03-6.73) were independent risk factors of in-hospital death. A nomogram based on the identified risk factors was developed to predict the individual probability of in-hospital mortality. The nomogram demonstrated satisfactory performance in terms of classification ability (area under the curve [AUC]: 0.759), calibration ability, and net clinical benefit.
Fungi-related nosocomial infections are prevalent among cancer patients and are associated with poor prognosis. The constructed nomogram provides an invaluable tool for oncologists, enabling them to make timely and informed clinical decisions that offer substantial net clinical benefit to patients.
恶性肿瘤患者发生医院感染的风险较高。然而，由于真菌感染导致的癌症患者医院感染的临床特征和预后因素的相关研究有限。本研究旨在探讨住院真菌感染患者的临床特征，并建立列线图以预测住院癌症患者真菌感染期间院内死亡的风险。
本回顾性观察性研究纳入 2013 年 9 月至 2021 年 9 月期间发生院内真菌感染的癌症患者。采用单因素和多因素 logistic 回归分析确定院内死亡的独立预测因素。在多因素分析中显示统计学差异的变量被用于构建列线图，以个性化预测与医院真菌感染相关的院内死亡风险。通过受试者工作特征 (ROC) 曲线、校准曲线和决策曲线分析评估列线图的预测性能。
共纳入 216 名参与者，其中 57 名发生院内死亡。最常见的真菌种类为白念珠菌（68.0%）。呼吸道感染占真菌感染的比例最高（59.0%），其次是腹腔内感染（8.8%）。多因素回归分析显示，美国东部肿瘤协作组体能状态（ECOG-PS）3-4 分（比值比 [OR] = 6.08，95%置信区间 [CI]：2.04-18.12）、肺转移（OR = 2.76，95%CI：1.11-6.85）、血小板减少症（OR = 2.58，95%CI：1.21-5.47）、低白蛋白血症（OR = 2.44，95%CI：1.22-4.90）和机械通气（OR = 2.64，95%CI：1.03-6.73）是院内死亡的独立危险因素。基于确定的危险因素开发了一个列线图，以预测个体院内死亡的概率。该列线图在分类能力（曲线下面积 [AUC]：0.759）、校准能力和净临床获益方面表现出良好的性能。
真菌相关医院感染在癌症患者中较为常见，与不良预后相关。所构建的列线图为肿瘤学家提供了有价值的工具，使他们能够及时做出明智的临床决策，为患者带来实质性的净临床获益。
