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

E. Geoffrey Playford, Jeffrey Lipman, Michael Jones, Anna F. Lau, Masrura Kabir, Sharon C A Chen, Deborah J. Marriott, Ian Seppelt, Thomas Gottlieb, Winston Cheung, Jonathan R. Iredell, Emma S. McBryde, Tania C. Sorrell*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)

Abstract

Background: Delayed antifungal therapy for invasive candidiasis (IC) contributes to poor outcomes. Predictive risk models may allow targeted antifungal prophylaxis to those at greatest risk.

Methods: A 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 with Candida species 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.

Results: Ninety-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%).

Conclusions: Dichotomization 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.

Original languageEnglish
Pages (from-to)1463-1469
Number of pages7
JournalClinical Infectious Diseases
Volume63
Issue number11
DOIs
Publication statusPublished - 1 Dec 2016

Keywords

  • Candidemia
  • Critical care
  • Invasive candidiasis
  • Prophylaxis
  • Risk prediction

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