Abstract
BackgroundCandidemia has emerged as an important nosocomial infection, with a mortality rate of 30–50%. It is the fourth most common nosocomial bloodstream infection (BSI) in the United States and the seventh most common nosocomial BSI in Europe and Japan. The aim of this study was to assess the performance of the Sequential Organ Failure Assessment (SOFA) score for determining the severity and prognosis of candidemia.MethodsWe performed a retrospective study of patients admitted to hospital with candidemia between September 2014 and May 2018. The severity of candidemia was evaluated using the SOFA score and the Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) score. Patients’ underlying diseases were assessed by the Charlson Comorbidity Index (CCI).ResultsOf 70 patients enrolled, 41 (59%) were males, and 29 (41%) were females. Their median age was 73 years (range: 36–93 years). The most common infection site was catheter-related bloodstream infection (n=36, 51%).The 30-day, and in-hospital mortality rates were 36 and 43%, respectively.Univariate analysis showed that SOFA score ≥5, APACHE II score ≥13, initial antifungal treatment with echinocandin, albumin < 2.3, C-reactive protein > 6, disturbance of consciousness, and CCI ≥3 were related with 30-day mortality. Of these 7, multivariate analysis showed that the combination of SOFA score ≥5 and CCI ≥3 was the best independent prognostic indicator for 30-day and in-hospital mortality.ConclusionsThe combined SOFA score and CCI was a better predictor of the 30-day mortality and in-hospital mortality than the APACHE II score alone.
Highlights
Candidemia has emerged as an important nosocomial infection, with a mortality rate of 30–50%
The combined Sequential Organ Failure Assessment (SOFA) score and Charlson Comorbidity Index (CCI) was a better predictor of the 30-day mortality and in-hospital mortality than the APACHE Acute Physiology (II) score alone
It has been reported that quick Sequential Organ Failure Assessment and Sequential Organ Failure Assessment (SOFA) scores are reliable as prognostic tools in the management of sepsis and other infections [8,9,10]. qSOFA and SOFA consist of 3 to 5 items and are simpler to administer than APACHE II, and are suitable for use by all physicians
Summary
Candidemia has emerged as an important nosocomial infection, with a mortality rate of 30–50%. Reported risk factors for candidemia include central venous catheterization (CVC), neutropenia, malignancy, abdominal surgery within the previous 30 days, immunosuppressant use and admission to an intensive care unit (ICU). The ubiquity of these risk factors means that most physicians may encounter patients with candidemia. We hypothesize that the Charlson Comorbidity Index (CCI) which is commonly used for the evaluation of comorbidity in general wards, would be appropriate for evaluating the patients’ condition We conducted this retrospective study to assess whether qSOFA and SOFA scores plus CCI could predict mortality in patients with candidemia
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