Zhang et al reported a risk score for invasive candidiasis in an adult in the intensive care unit (ICU). The authors are from the Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing.
Patient selection: adult in ICU >= 48 hours with clinical signs of infection
Exclusions: pregnant, lactating, neutropenia, other fungal infection
Parameters:
(1) absolute CD8 positive T cell count per microliter
(2) receipt of high-dose corticosteroids (>= 50 mg prednisolone equivalent)
(3) therapy with carbapenem/tigecycline
(4) APACHE II score
(5) blood test for BDG = (1,3)-beta-D-glycan
(6) emergency gastrointestinal, hepatic, pancreatic or biliary surgery
|
Parameter
|
Finding
|
Points
|
|
absolute CD8 T cell count
|
> 143 per µL
|
0
|
|
|
<= 143 per µL
|
1
|
|
high dose steroids
|
no
|
0
|
|
|
yes
|
1
|
|
carbapenem/tigecycline
|
no
|
0
|
|
|
yes
|
1
|
|
APACHE II
|
< 15
|
0
|
|
|
>= 15
|
1
|
|
blood test BDG
|
negative
|
0
|
|
|
positive
|
1
|
|
emergency GI/HPB surgery
|
no
|
0
|
|
|
yes
|
2
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 7
|
Total Score
|
Rosl of Invasive Candidiasis
|
Percent
|
|
0 to 2
|
low
|
1-2%
|
|
3 or 4
|
moderate
|
12-13%
|
|
5 to 7
|
high
|
25-34%
|
Perforamnce:
• The area under the ROC curve is 0.82.
