Abstract
IntroductionCandidemia in critically ill patients is usually a severe and life-threatening condition with a high crude mortality. Very few studies have focused on the impact of candidemia on ICU patient outcome and attributable mortality still remains controversial. This study was carried out to determine the attributable mortality of ICU-acquired candidemia in critically ill patients using propensity score matching analysis.MethodsA prospective observational study was conducted of all consecutive non-neutropenic adult patients admitted for at least seven days to 36 ICUs in Spain, France, and Argentina between April 2006 and June 2007. The probability of developing candidemia was estimated using a multivariate logistic regression model. Each patient with ICU-acquired candidemia was matched with two control patients with the nearest available Mahalanobis metric matching within the calipers defined by the propensity score. Standardized differences tests (SDT) for each variable before and after matching were calculated. Attributable mortality was determined by a modified Poisson regression model adjusted by those variables that still presented certain misalignments defined as a SDT > 10%.ResultsThirty-eight candidemias were diagnosed in 1,107 patients (34.3 episodes/1,000 ICU patients). Patients with and without candidemia had an ICU crude mortality of 52.6% versus 20.6% (P < 0.001) and a crude hospital mortality of 55.3% versus 29.6% (P = 0.01), respectively. In the propensity matched analysis, the corresponding figures were 51.4% versus 37.1% (P = 0.222) and 54.3% versus 50% (P = 0.680). After controlling residual confusion by the Poisson regression model, the relative risk (RR) of ICU- and hospital-attributable mortality from candidemia was RR 1.298 (95% confidence interval (CI) 0.88 to 1.98) and RR 1.096 (95% CI 0.68 to 1.69), respectively.ConclusionsICU-acquired candidemia in critically ill patients is not associated with an increase in either ICU or hospital mortality.
Highlights
Candidemia in critically ill patients is usually a severe and life-threatening condition with a high crude mortality
Infections were caused by C. albicans in 22 episodes, C. parapsilosis in nine, C. tropicalis in three, C. glabrata in two, C. krusei in one and Candida ssp. in one
The distribution of variables including severity indexes, ICU length of stay and mortality was similar in patients with candidemia caused by C. albicans and nonalbicans Candida spp
Summary
Candidemia in critically ill patients is usually a severe and life-threatening condition with a high crude mortality. Candidemia in critically ill patients is usually a severe and life-threatening condition with a high crude mortality ranging between 35% and 75% [5,6]. There is an interest in conducting case-control or matched cohort studies in which attributable mortality is obtained after matching and adjusting for confounding variables. Despite these techniques it seems almost impossible to match all factors (observable and unobservable) than can potentially have an influence upon mortality. This obstacle was overcome by Rosenbaum and Rubin [8]
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