Shorr et al developed a simple risk score for identifying candidemia in a patient being admitted to the hospital. Early recognition of candidemia with initiation of appropriate therapy can improve patient survival. The authors are from Washington Hospital Center (Washington, D.C.), Brigham and Women's Hospital, Washington University (St. Louis), Astellas Pharma US Inc (Deerfield, IL), and CareFusion (Marlborough, MA).
Patient selection: admission to an acute care hospital
Parameters:
(1) age
(2) nutritional status
(3) body temperature and mental status
(4) previous hospitalization
(5) transfer from another healthcare facility
(6) respiratory status at admission
|
Parameter |
Finding |
Points |
|
age |
< 65 years |
1 |
|
|
>= 65 years |
0 |
|
nutritional status |
cachectic |
1 |
|
|
not cachectic |
0 |
|
body temperature or mental status |
temperature <= 98°F (< 36.7°C) OR severely altered mental status |
1 |
|
|
temperature > 98°F AND normal to moderately altered mental status |
0 |
|
previous hospitalization |
within past 30 days |
1 |
|
|
none or more than 30 days ago |
0 |
|
transfer from another facility |
yes |
1 |
|
|
no |
0 |
|
respiratory status |
requires mechanical ventilation |
1 |
|
|
does not require mechanical ventilation |
0 |
where:
• Being transferred from another healthcare facility does not qualify for a hospital admission within the past month.
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
• The higher the score the more likely that the patient has candidemia.
|
Total Score |
Risk Candidemia |
|
0 |
0.4% |
|
1 |
0.8% |
|
2 |
2% |
|
3 |
3% |
|
4 |
4-5% |
|
5 |
about 9% |
|
6 |
about 20% |
Performance:
• A score <= 2 had a negative predictive value of 99%.
• The area under the ROC curve was 0.71 which is not impressive.
• Performance could be combining the score with known risk factors for Candida infections and urinalysis.
Additional factors associated with candidemia not included in score:
(1) serum albumin <= 2.2 g/dL (associated with cachexia)
(2) arterial pH <= 7.36
(3) serum sodium > 145 mmol/L
(4) serum potassium > 5.6 mmol/L
Specialty: Infectious Diseases
ICD-10: ,
