Labelle et al identified factors predicting mortality in a hospitalized patient with Candidemia (Candida bloodstream infection). These can help to identify a patient who may benefit from more aggressive management. The authors are from Washington University and Barnes-Jewish Hospital in Saint Louis, Missouri.
Prognostic factors
(1) APACHE II score in the 24 hours after the positive blood culture was drawn
(2) initial dose of fluconazole used to treat the patient
(3) status of an central vein catheter
(4) corticosteroid use
Prognostic Factor
Hazard Ratio in ICU
Hazard Ratio not in ICU
APACHE II score
1.2 per point
1.18 per point
initial fluconazole dose inadequate
9.2
3.3
failure to remove central vein catheter
6.2
4.9
corticosteroid use
1.0
3.4
where:
• Candida krusei is not susceptible to fluconazole.
In Figures 1 and 2 they show survival based on 3 risk factors: failure to remove central vein catheter, inadequate initial fluconazole dose and delay in giving antifungal therapy for > 48 hours.
Number of Risk Factors
Mortality in ICU
Mortality Not in ICU
0
17%
17%
1
40%
27%
2
62%
60%
3
100%
100%
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