Modified candida scoring system for detection of high risk ICU admitted patients

Frequency (percentage) were recorded for categorical variables. In
order to explore the independent nature of the variables, ?2 were used. To estimate
the predictive model that will allow us to differentiate between Candida
species and proven candidal infection, the crude odds ratio (OR) for each risk
factor associated with proven candidal infection was estimated. Statistical
significance was accepted at the 5% level. Statistically significant variables
in the univariate analysis were included in the model, and through a stepwise
elimination process, the so-called “Modified Candida score” was obtained using
logistic regression. The discriminatory power of this score was evaluated by
the area under the receiver operating characteristics (ROC) curve and the 95%
confidence interval (CI). Then, a cut-off specificity in the validation set was
selected. The results were analyzed using SPSS 14.0 software (SPSS, Chicago,
IL, USA) and SAS version 9.2 statistical software (SAS Institute, Inc).

 

 

Results

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Of the 750 patients, 85 (113%) patients were
diagnosed with invasive candidiasis (IC). There were 64 (75.3%) men and 21
(24.7%) women in this group, with a mean age of 58.5 (±16.9) years. The frequencies of the patients based on the risk factors,
were recorded in the Table 1. As the table1 shows, rates of patients with risk factors are higher than in
diagnosed IC patients except of diabetes mellitus, hemodialysis and mechanical ventilation. There was no statistically
significant difference concerning the corticosteroids consumption,
immunosuppressive therapy, chronic renal failure, diabetes mellitus,
hemodialysis and mechanical ventilation between two groups.

In the logit model adjusted for possible confounding
variables, surgery on ICU admission, total parenteral nutrition, ICU stay>7 days, broad antibiotic therapy, pancreatitis, central venous catheter, and severe
sepsis were independently associated with a greater risk for proven candidal
infection (Table 2). Through a stepwise elimination process, the Candida
score was obtained (Table 3). The discriminatory power of this score,
assessed by the area under the ROC curve and its main cut-off values, is shown
in Figure 1. Area under curve (AUC) was estimated 0.86 and sensitivity
and specificity in cutoff point 4 are suitable, 0.83 and 0.80 respectively. Table
4 shows the result of the comparison of sensitivity and specificity based
on performance of Candida score and Modified Candida score systems
according to test introduced by Newcombe (16).
There is no significant difference between sensitivity systems (p=0.234) but in contrast, specificity modified candida score was
significant higher than specificity candida score (p=0.025).

 

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