Saricaoglu Elif Mukime, Hekimoglu Melike Inan, Gulten Ezgi, Akdemir Irem, Cinar Gule, Yilmaz Afife Zeynep, Ocal Duygu, Kar Irem, Memikoglu Kemal Osman, Yoruk Fugen
Ankara University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
Ankara University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey.
Mycoses. 2025 Sep;68(9):e70119. doi: 10.1111/myc.70119.
Candidaemia is a life-threatening infection with a persistently high mortality rate, despite significant advances in antifungal therapy and supportive care. The European Confederation of Medical Mycology developed the EQUAL Candida Score as a standardised tool to evaluate adherence to guideline-based management; however, its prognostic value has not been consistently demonstrated in different patient populations. This study aimed to evaluate the clinical impact of adhering to guidelines and determine the predictive value of the EQUAL Candida Score for mortality risk in candidaemia patients.
This retrospective cohort study included adult patients with candidaemia who were treated at a tertiary care hospital. Patients were classified as survivors or nonsurvivors based on 90-day candidaemia-related mortality. We identified independent predictors of mortality using multivariable Cox regression analysis and subsequently developed a prognostic nomogram based on the final model.
A total of 189 patients with candidaemia were included in the study, of whom 88 (46.6%) died within 90 days. The median EQUAL Candida Score was significantly lower among nonsurvivors compared with survivors (8 vs. 13, p < 0.001). This prognostic association remained consistent in subgroup analyses, both in patients with (10 vs. 13, p < 0.001) and without (10 vs. 13, p = 0.022) central venous catheters. An optimal cut-off score of 12 was identified across all groups, yielding a sensitivity of 70%-80% and a specificity of 79%. Kaplan-Meier survival analysis further confirmed that patients with an EQUAL Score ≥ 12 had significantly higher survival rates in all subgroups. In multivariable Cox regression, immunosuppressive treatment (HR 1.728), septic shock (HR 2.035), lack of source control (HR 2.013) and an EQUAL Score < 12 (HR 3.503) were identified as independent predictors of candidaemia-related mortality. Based on these variables, a nomogram was developed to estimate individualised survival probabilities at 1, 3 and 6 months. External validation in an independent cohort (n = 64) confirmed the model's prognostic performance, with a Harrell's C-index of 0.704 (95% CI: 0.587-0.821), despite the limited sample size.
The EQUAL Candida Score serves as a reliable prognostic marker for candidaemia. When combined with clinical parameters, it enhances the accuracy of mortality risk estimation. Our novel nomogram provides a practical framework for early risk stratification and may optimise management strategies for high-risk patients.
念珠菌血症是一种危及生命的感染，尽管抗真菌治疗和支持治疗取得了显著进展，但其死亡率一直居高不下。欧洲医学真菌学联合会制定了EQUAL念珠菌评分作为评估基于指南管理依从性的标准化工具；然而，其预后价值在不同患者群体中尚未得到一致证实。本研究旨在评估遵循指南的临床影响，并确定EQUAL念珠菌评分对念珠菌血症患者死亡风险的预测价值。
这项回顾性队列研究纳入了在一家三级护理医院接受治疗的成年念珠菌血症患者。根据90天念珠菌血症相关死亡率将患者分为幸存者或非幸存者。我们使用多变量Cox回归分析确定死亡率的独立预测因素，并随后基于最终模型开发了一个预后列线图。
该研究共纳入189例念珠菌血症患者，其中88例（46.6%）在90天内死亡。与幸存者相比，非幸存者的EQUAL念珠菌评分中位数显著更低（8对13，p<0.001）。在亚组分析中，这种预后关联在有（10对13，p<0.001）和无（10对13，p=0.022）中心静脉导管的患者中均保持一致。在所有组中确定的最佳截断评分为12，敏感性为70%-80%，特异性为79%。Kaplan-Meier生存分析进一步证实，EQUAL评分≥12的患者在所有亚组中的生存率显著更高。在多变量Cox回归中，免疫抑制治疗（HR 1.728）、感染性休克（HR 2.035）、缺乏源头控制（HR 2.013）和EQUAL评分<12（HR 3.503）被确定为念珠菌血症相关死亡率的独立预测因素。基于这些变量，开发了一个列线图来估计1、3和6个月时的个体化生存概率。在一个独立队列（n=64）中的外部验证证实了该模型的预后性能，尽管样本量有限，Harrell's C指数为0.704（95%CI：0.587-0.821）。
EQUAL念珠菌评分是念珠菌血症的可靠预后标志物。当与临床参数相结合时，它提高了死亡风险估计的准确性。我们的新型列线图为早期风险分层提供了一个实用框架，并可能优化高危患者的管理策略。
