A scoring system based on novel biomarkers and clinical risk factors to predict invasive candidiasis in immunocompetent critically ill patients

Wen Li; Gang Chen; Fengyu Lin; Hang Yang; Yanhui Cui; Rongli Lu; Chao Song; Haitao Li; Yi Li; Pinhua Pan

doi:10.3389/fmicb.2023.1097574

A scoring system based on novel biomarkers and clinical risk factors to predict invasive candidiasis in immunocompetent critically ill patients

Front Microbiol. 2023 Mar 9:14:1097574. doi: 10.3389/fmicb.2023.1097574. eCollection 2023.

Authors

Wen Li^{1

2

3

4

5}, Gang Chen^{1

2

3

4

5}, Fengyu Lin^{1

2

3

4

5}, Hang Yang^{1

2

3

4

5}, Yanhui Cui^{1

2

3

4

5}, Rongli Lu^{1

2

3

4

5}, Chao Song⁶, Haitao Li⁷, Yi Li^{1

2

3

4

5}, Pinhua Pan^{1

2

3

4

5}

Affiliations

¹ Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China.
² Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.
³ Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China.
⁴ National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.
⁵ Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China.
⁶ Nosocomial Infection Control Center, Xiangya Hospital, Central South University, Changsha, China.
⁷ First Department of Thoracic Medicine, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.

Abstract

Background: Delayed diagnosis further increases the mortality of invasive candidiasis (IC) in intensive care unit (ICU) patients. This study aimed to develop and validate a score based on novel serological biomarkers and clinical risk factors for predicting IC in immunocompetent ICU patients.

Methods: We retrospectively collected clinical data and novel serological markers on admission to ICU. Multivariate logistic regression was used to identify the risk factors associated with IC, which were adopted to establish a scoring system.

Results: Patients with IC had a higher C-reactive protein-to-albumin ratio (CAR) and neutrophil-to-lymphocyte ratio (NLR) and lower prognostic nutritional index than those without IC. The NLR, CAR, sepsis, total parenteral nutrition, 1,3-β-D-glucan (BDG)-positivity, and Sequential Organ Failure Assessment score were identified as independent risk factors for IC by multivariate logistic regression analysis and entered into the final scoring system. The area under receiver operating characteristic curve of the score were 0.883 and 0.892, respectively, in the development and validation cohort, higher than Candida score (0.883 vs.0.730, p < 0.001).

Conclusion: We established a parsimonious score based on NLR, CAR, BDG-positivity, and clinical risk factors, which can accurately identify IC in ICU patients to give treatment on time and reduce mortality.

Keywords: critically ill patients; immunocompetent; invasive candidiasis; novel serological biomarkers; scoring system.