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

Abstract

BackgroundDelayed 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.MethodsWe 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.ResultsPatients 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).ConclusionWe 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.

Gram-Negative Bloodstream Infections in Healthcare: The Relationship Between Antibiotic Resistance, Mortality, and Novel Serological Biomarker

“…Li et al found that the novel biomarkers CAR, NLR, and PNI were significantly altered in patients with invasive candidiasis. These biomarkers were significantly associated with disease severity and prognosis of ICU patients [ 6 ]. PNI is a nutritional index.…”

“…These markers are composed of two or more clinical laboratory indicators. The novel biomarker and their formulas are as follows; CAR = CRP (C-reactive protein) (mg/L) /albumin(g/L), NLR = neutrophil counts (10 9 /L) /lymphocyte counts(10 9 /L), PNI (Prognostic nutritional index) = 10 × albumin(g/L) + 5 × lymphocyte count (10 9 /L), PLR (platelet-to-lymphocyte ratio) = platelet counts (10 9 /L) /lymphocyte counts (10 9 /L), SII (systemic immune inflammation index) = platelet count (10 9 /L) × neutrophil count (10 9 /L)/lymphocyte count (10 9 /L) [ 6 ].…”

Editorial to ‘A score for predicting invasive pulmonary aspergillosis in immunocompetent critically ill patients’

“…In this issue of the European Journal of Clinical Investigation, Li et al 9 have proposed a clinical-laboratory prediction score for diagnosing IPA in an immunocompetent critically ill population. In the retrospective study by Li et al, 9 1841 immunocompetent patients admitted to ICU were randomly assigned to training and validation cohorts.…”

“…In this issue of the European Journal of Clinical Investigation, Li et al 9 have proposed a clinical-laboratory prediction score for diagnosing IPA in an immunocompetent critically ill population. In the retrospective study by Li et al, 9 1841 immunocompetent patients admitted to ICU were randomly assigned to training and validation cohorts. A prediction score was developed with host factors such as chronic obstructive pulmonary disease (COPD), continuous renal replacement therapy (CRRT), broad-spectrum antibiotics utilization and laboratory tests [i.e.…”

“…The paper by Li et al 9 addresses an intriguing issue since the prevalence of IPA in immunocompetent critically ill patients has become evident during the COVID-19 pandemic, raising concerns about this superinfection as an additional contributing factor to mortality. 10 Indeed, a prospective cohort study involving 108 critically ill patients with acute respiratory distress syndrome (ARDS) revealed higher 30-day mortality among patients with than without IPA (44% vs. 19%).…”