Prediction of invasive candidal infection in critically ill patients with severe acute pancreatitis.
Prediction of invasive candidal infection in critically ill patients with severe acute pancreatitis.
复制标题
DOI：
10.1186/cc12569
复制
发表时间：
2013-03-18
期刊：
影响因子：
--
通讯作者：
Hampshire PA
中科院分区：
文献类型：
--
作者：
Hall AM;Poole LA;Renton B;Wozniak A;Fisher M;Neal T;Halloran CM;Cox T;Hampshire PA
重症急性胰腺炎患者面临念珠菌感染的风险，并存在死亡率增加的潜在风险。由于早期诊断是有问题的，已经开发了几种临床风险评分来识别处于风险中的患者。这些患者可能受益于预防性抗真菌治疗，而那些感染风险低的患者可能不会受益，并可能受到伤害。本研究的目的是评估重症急性胰腺炎患者侵袭性念珠菌感染的现有风险评分的有效性和区分度。对重症监护室收治的重症急性胰腺炎患者进行了分析。结果和危险因素的入院与念珠菌感染和无进行了比较。评估了侵袭性念珠菌感染发展的三种现有风险评分（念珠菌评分、念珠菌定植指数评分和侵袭性念珠菌病评分）的准确性和区分度。从2003年到2011年，共确定了101例患者，其中18例（17.8%）发生了念珠菌感染。30例患者死亡，总住院死亡率为29.7%。念珠菌感染患者的住院死亡率显著较高（55.6%比24.1%，P = 0.02）。多变量分析显示念珠菌定植与随后的念珠菌感染相关。念珠菌定植指数评分是最准确的测试，特异性为0.79（95%置信区间[CI] 0.68至0.88），灵敏度为0.67（95% CI 0.41至0.87），阴性预测值为0.91（95% CI 0.82至0.97），阳性似然比为3.2（95% CI 1.9至5.5）。念珠菌定植指数评分显示最佳区分度，受试者工作特征曲线下面积为0.79（95% CI 0.69 - 0.87）。在这项研究中，念珠菌定植指数评分是确定哪些重症急性胰腺炎患者有发生念珠菌感染风险的最准确和最具鉴别力的测试。然而，其低灵敏度可能限制其临床用途。
Patients with severe acute pancreatitis are at risk of candidal infections carrying the potential risk of an increase in mortality. Since early diagnosis is problematic, several clinical risk scores have been developed to identify patients at risk. Such patients may benefit from prophylactic antifungal therapy while those patients who have a low risk of infection may not benefit and may be harmed. The aim of this study was to assess the validity and discrimination of existing risk scores for invasive candidal infections in patients with severe acute pancreatitis. Patients admitted with severe acute pancreatitis to the intensive care unit were analysed. Outcomes and risk factors of admissions with and without candidal infection were compared. Accuracy and discrimination of three existing risk scores for the development of invasive candidal infection (Candida score, Candida Colonisation Index Score and the Invasive Candidiasis Score) were assessed. A total of 101 patients were identified from 2003 to 2011 and 18 (17.8%) of these developed candidal infection. Thirty patients died, giving an overall hospital mortality of 29.7%. Hospital mortality was significantly higher in patients with candidal infection (55.6% compared to 24.1%, P = 0.02). Candida colonisation was associated with subsequent candidal infection on multivariate analysis. The Candida Colonisation Index Score was the most accurate test, with specificity of 0.79 (95% confidence interval [CI] 0.68 to 0.88), sensitivity of 0.67 (95% CI 0.41 to 0.87), negative predictive value of 0.91 (95% CI 0.82 to 0.97) and a positive likelihood ratio of 3.2 (95% CI 1.9 to 5.5). The Candida Colonisation Index Score showed the best discrimination with area under the receiver operating characteristic curve of 0.79 (95% CI 0.69 to 0.87). In this study the Candida Colonisation Index Score was the most accurate and discriminative test at identifying which patients with severe acute pancreatitis are at risk of developing candidal infection. However its low sensitivity may limit its clinical usefulness.
登录
查看更多内容
影响因子：
11.8
作者：
Marchetti, O;Bille, J;Pittet, D
通讯作者：
Pittet, D
DOI：
10.1007/s10096-007-0270-z
发表时间：
2007-04-01
影响因子：
4.5
作者：
Ostrosky-Zeichner, L.;Sable, C.;Rex, J. H.
通讯作者：
Rex, J. H.
影响因子：
38.9
作者：
Garbino, J;Lew, DP;Pittet, D
通讯作者：
Pittet, D
DOI：
10.1111/j.1440-1746.2008.05712.x
发表时间：
2009-05-01
影响因子：
4.1
作者：
Kochhar, Rakesh;Ahammed, S. K. Mahiuddin;Singh, Kartar
通讯作者：
Singh, Kartar
影响因子：
8.8
作者：
León, C;Ruiz-Santana, S;León, MA
通讯作者：
León, MA