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

Playford, E. Geoffrey, Lipman, Jeffrey, Jones, Michael, Lau, Anna F., Kabir, Masrura, Chen, Sharon C. -A., Marriott, Deborah J., Seppelt, Ian, Gottlieb, Thomas, Cheung, Winston, Iredell, Jonathan R., McBryde, Emma S. and Sorrell, Tania C. (2016) 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. Clinical Infectious Diseases, 63 11: 1463-1469. doi:10.1093/cid/ciw610


Author Playford, E. Geoffrey
Lipman, Jeffrey
Jones, Michael
Lau, Anna F.
Kabir, Masrura
Chen, Sharon C. -A.
Marriott, Deborah J.
Seppelt, Ian
Gottlieb, Thomas
Cheung, Winston
Iredell, Jonathan R.
McBryde, Emma S.
Sorrell, Tania C.
Title 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
Journal name Clinical Infectious Diseases   Check publisher's open access policy
ISSN 1058-4838
1537-6591
Publication date 2016-12-01
Sub-type Article (original research)
DOI 10.1093/cid/ciw610
Open Access Status Not yet assessed
Volume 63
Issue 11
Start page 1463
End page 1469
Total pages 7
Place of publication Cary, NC, United States
Publisher Oxford University Press
Language eng
Formatted 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.
Keyword Invasive candidiasis
Risk prediction
Critical care
Prophylaxis
Candidemia
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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