Abstract
Candidemia causes high mortality and is occuring at increasing rate in intensive care units (ICUs). (1,3)- β-D-glucan (BDG) testing is recommended in neutropenic patients. However the usefulness of BDG in ICUs is unclear. This study was conducted to compare the diagnostic value of Candida score (CS), colonization index (CI), serum BDG detection, and routine laboratory parameters in ICU patients. Characteristics and laboratory data of 83 patients (15 patients with candidemia and 68 patients without candidemia) were evaluated. Median serum BDG was significantly higher in the candidemia group (129 pg/mL vs. 36 pg/mL, p < 0.001). BDG assay with standard cut-off value ≥ of 80 pg/mL had 93.33% sensitivity and 64.18% specificity (Areas under the ROC curve (AUC): 0.788). This study concluded that the optimal cut-off value for BDG assay was 112 pg/mL with sensitivity of 86.67% and specificity of 82.09% (AUC: 0.844). C-reactive protein (CRP) with optimal cut-off value ≥ 85 mg/L and BDG ≥ 80 pg/mL had the highest AUC (0.862, 95% CI: 0.768 - 0.928) with sensitivity 93.33% and specificity 79.1%. Predicting candidemia is essential in critically ill patients who are at high risk and have high mortality rates. The results of this study suggest that BDG testing is useful for predicting candidemia in ICU. However, BDG combined with CRP may be a stronger predictor for candidemia.
Highlights
Candidemia causes high mortality and is occuring at increasing rate in intensive care units (ICUs). (1,3)- β-D-glucan (BDG) testing is recommended in neutropenic patients
Risk factors of candidemia such as total parenteral nutrition (TPN), central venous catheterization (CVC), immunosuppressive agents, and surgery are well described in ICUs [4-6]
Of the 137 patients admitted to ICU during the study period, 83 met the inclusion criteria specified above, and were enrolled in the study
Summary
Candidemia causes high mortality and is occuring at increasing rate in intensive care units (ICUs). (1,3)- β-D-glucan (BDG) testing is recommended in neutropenic patients. Methodology: This study was conducted to compare the diagnostic value of Candida score (CS), colonization index (CI), serum BDG detection, and routine laboratory parameters in ICU patients. BDG assay with standard cut-off value ≥ of 80 pg/mL had 93.33% sensitivity and 64.18% specificity (Areas under the ROC curve (AUC): 0.788). This study concluded that the optimal cut-off value for BDG assay was 112 pg/mL with sensitivity of 86.67% and specificity of 82.09% (AUC: 0.844). C-reactive protein (CRP) with optimal cut-off value ≥ 85 mg/L and BDG ≥ 80 pg/mL had the highest AUC (0.862, 95% CI: 0.768 - 0.928) with sensitivity 93.33% and specificity 79.1%. Candidemia is a blood-stream infection observed at increasing rates in non-neutropenic patients admitted to intensive care units (ICUs) and causes high mortality [2,3]. Colonization index (CI) and Candida score (CS) ≥ 3 are used in clinical practice in ICUs [10,11]
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