Problematic Dichotomization of Risk for Intensive Care Unit (ICU)-Acquired Invasive Candidiasis: Results Using a Risk-Predictive Model to Categorize 3 Levels of Risk From a Multicenter Prospective Cohort of Australian ICU Patients.
Problematic Dichotomization of Risk for Intensive Care Unit (ICU)-Acquired Invasive Candidiasis: Results Using a Risk-Predictive Model to Categorize 3 Levels of Risk From a Multicenter Prospective Cohort of Australian ICU Patients.
复制标题
重症监护病房 (ICU) 获得性侵袭性念珠菌病风险的问题二分法：使用风险预测模型对澳大利亚 ICU 患者多中心前瞻性队列进行 3 级风险分类的结果。
DOI：
10.1093/cid/ciw610
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Sorrell,TaniaC
中科院分区：
文献类型：
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作者：
Playford,EGeoffrey;Lipman,Jeffrey;Jones,Michael;Lau,AnnaF;Kabir,Masrura;Chen,SharonC-A;Marriott,DeborahJ;Seppelt,Ian;Gottlieb,Thomas;Cheung,Winston;Iredell,JonathanR;McBryde,EmmaS;Sorrell,TaniaC
背景侵袭性念珠菌病（IC）的抗真菌治疗延迟会导致不良结局。预测风险模型可能允许有针对性的抗真菌药物预防那些在最大的risk.MethodsA前瞻性队列研究的6685连续nonalcipenic患者入住7澳大利亚重症监护病房（ICU）≥72小时。对ICU入院前后IC发生的临床风险因素、每周两次评估的3个研究中心监测培养物上的细菌定植以及ICU入院后≥72小时或ICU出院后≤72小时IC的发生进行了测量。从这些参数，ICU获得IC的发展的风险预测模型，然后derived.Results96例（1.43%）开发ICU获得IC。使用10个与IC相关的独立显著变量的简单求和风险预测模型显示出总体中等准确性（受试者工作特征曲线下面积= 0.82）。没有单一的阈值评分可以将患者分为临床有用的高风险组和低风险组。然而，使用2个阈值评分，可以确定3个患者队列：高风险人群（评分≥6，占总队列的4.8%，阳性预测值[PPV] 11.7%），低风险患者（评分≤2，占总队列的43.1%，PPV 0.24%）和中度风险患者（评分3-5分，占总队列的52.1%，PPV为1.46%）。将患者分为高、中、低风险组可能更有效地针对早期抗真菌策略和利用新的诊断测试。
BackgroundDelayed antifungal therapy for invasive candidiasis (IC) contributes to poor outcomes. Predictive risk models may allow targeted antifungal prophylaxis to those at greatest risk.MethodsA prospective cohort study of 6685 consecutive nonneutropenic patients admitted to 7 Australian intensive care units (ICUs) for ≥72 hours was performed. Clinical risk factors for IC occurring prior to and following ICU admission, colonization withCandidaspecies on surveillance cultures from 3 sites assessed twice weekly, and the occurrence of IC ≥72 hours following ICU admission or ≤72 hours following ICU discharge were measured. From these parameters, a risk-predictive model for the development of ICU-acquired IC was then derived.ResultsNinety-six patients (1.43%) developed ICU-acquired IC. A simple summation risk-predictive model using the 10 independently significant variables associated with IC demonstrated overall moderate accuracy (area under the receiver operating characteristic curve = 0.82). No single threshold score could categorize patients into clinically useful high- and low-risk groups. However, using 2 threshold scores, 3 patient cohorts could be identified: those at high risk (score ≥6, 4.8% of total cohort, positive predictive value [PPV] 11.7%), those at low risk (score ≤2, 43.1% of total cohort, PPV 0.24%), and those at intermediate risk (score 3–5, 52.1% of total cohort, PPV 1.46%).ConclusionsDichotomization of ICU patients into high- and low-risk groups for IC risk is problematic. Categorizing patients into high-, intermediate-, and low-risk groups may more efficiently target early antifungal strategies and utilization of newer diagnostic tests.