Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting
Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting
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DOI：
10.1007/s10096-007-0270-z
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发表时间：
2007-04-01
影响因子：
4.5
通讯作者：
Rex, J. H.
中科院分区：
文献类型：
--
作者：
Ostrosky-Zeichner, L.;Sable, C.;Rex, J. H.
进行本研究的目的是建立一个规则，以确定在重症监护环境中侵袭性念珠菌病的高风险受试者。对在美国和巴西的9家医院至少住院4天的2，890名患者进行了回顾性审查和统计建模;该组中侵袭性念珠菌病的总发病率为3%（88例）。表现最好的规则如下：任何全身性抗生素（第1-3天）或存在中心静脉导管（第1-3天）和至少两种以下全胃肠外营养（第1-3天），任何透析（第1-3天）、任何大手术（第-7-0天）、胰腺炎（第-7-0天）、任何类固醇的使用（第-7-3天）或其他免疫抑制剂的使用（第-7-0天）。符合该规则的患者中侵袭性念珠菌病的发生率为9.9%，占该单位病例的34%，表现如下：相对危险度4.36，敏感度0.34，特异度0.90，阳性预测值0.01，阴性预测值0.97。该规则可以识别侵袭性念珠菌病的高风险患者。
The study presented here was performed in order to create a rule that identifies subjects at high risk for invasive candidiasis in the intensive care setting. Retrospective review and statistical modelling were carried out on 2,890 patients who stayed at least 4 days in nine hospitals in the USA and Brazil; the overall incidence of invasive candidiasis in this group was 3% (88 cases). The best performing rule was as follows: Any systemic antibiotic (days 1-3) OR presence of a central venous catheter (days 1-3) AND at least TWO of the following-total parenteral nutrition (days 1-3), any dialysis (days 1-3), any major surgery (days -7-0), pancreatitis (days -7-0), any use of steroids (days -7-3), or use of other immunosuppressive agents (days -7-0). The rate of invasive candidiasis among patients meeting the rule was 9.9%, capturing 34% of cases in the units, with the following performance: relative risk 4.36, sensitivity 0.34, specificity 0.90, positive predictive value 0.01, and negative predictive value 0.97. The rule may identify patients at high risk of invasive candidiasis.