The Overlooked Immune State in Candidemia: A Risk Factor for Mortality

Abstract

Lymphopenia has been related to increased mortality in septic patients. Nonetheless, the impact of lymphocyte count on candidemia mortality and prognosis has not been addressed. We conducted a retrospective study, including all admitted patients with candidemia from 2007 to 2016. We examined lymphocyte counts during the first 5 days following the diagnosis of candidemia. Multivariable logistic regression analysis was performed to determine the relationship between lymphocyte count and mortality. Classification and Regression Tree analysis was used to identify the best cut-off of lymphocyte count for mortality associated with candidemia. From 296 cases of candidemia, 115 died, (39.8% 30-day mortality). Low lymphocyte count was related to mortality and poor outcome (p < 0.001). Lymphocyte counts < 0.703 × 109 cells/L at diagnosis (area under the curve (AUC)-ROC, 0.783 ± 0.042; 95% confidence interval (CI), 0.700–0.867, p < 0.001), and lymphocyte count < 1.272 × 109 cells/L five days later (AUC-ROC, 0.791 ± 0.038; 95%CI, 0.716–0.866, p < 0.001) increased the odds of mortality five-fold (odds ratio (OR), 5.01; 95%CI, 2.39–10.93) at time of diagnosis, and three-fold (OR, 3.27; 95%CI, 1.24–8.62) by day 5, respectively. Low lymphocyte count is an independent predictor of mortality in patients with candidemia and might serve as a biomarker for predicting candidemia-associated mortality and poor outcome.

A seven-year surveillance study of the epidemiology, antifungal susceptibility, risk factors and mortality of candidaemia among paediatric and adult inpatients in a tertiary teaching hospital in China

“…Our data showed that the median age of patients with candidaemia and the proportion of males were similar to those in other studies [ 8 , 18 – 23 ]. Moreover, our study showed that the patients with candidaemia were hospitalised mostly in internal medicine wards, which is different from other studies that reporting hospitalisation mainly in ICU wards [ 8 , 22 , 24 – 27 ], but similar to other studies [ 28 – 31 ].…”

“…The change trend was similar to that reported by Oeser et al [38]. The overall morbidity and 30-day mortality in ICUs and hospitals in this study were similar to those in another hospital in this region of China [18], but lower than those in hospitals in other regions of China [35,37] and other countries [5,8,16,20,21,23,25,30]. The overall mortality rate of candidaemia has been reported to be 20-49% globally [39], and the mortality rate was 20.4% in our hospital, which is low compared to the global rate.…”

A seven-year surveillance study of the epidemiology, antifungal susceptibility, risk factors and mortality of candidaemia among paediatric and adult inpaitents in a tertiary teaching hospital in China

“…The change trend was similar to that reported by Oeser et al [38]. The overall morbidity and 30-day mortality in ICUs and hospitals in this study were similar to those in another hospital in this region of China [18], but lower than those in hospitals in other regions of China [35,37] and other countries [5,8,16,20,21,23,25,30]. The overall mortality rate of candidaemia has been reported to be 20%-49% globally [39], and the mortality rate was 20.4% in our hospital, which is low compared to the global rate.…”

A seven-year surveillance study of the epidemiology, antifungal susceptibility, risk factors and mortality of candidaemia among paediatric and adult inpatients in a tertiary teaching hospital in China

“…The change trend was similar to that reported by Oeser et al [38]. The overall morbidity and 30-day mortality in ICUs and hospitals in this study were similar to those in another hospital in this region of China [18], but lower than those in hospitals in other regions of China [35,37] and other countries [5,8,16,20,21,23,25,30]. It has been reported that the overall mortality rate of candidaemia is 20%-49% globally [39], and the mortality rate was 20.4% in our hospital, which is low compared to global rate.…”

“…Our data showed that the median age of patients with candidaemia and the proportion of males were similar to those in other studies [8,[18][19][20][21][22][23]. Moreover, our study showed that the patients with candidaemia were hospitalized mostly in internal medicine wards, which was different from other studies that reported hospitalisation in mainly ICU wards [8,22,[24][25][26][27], and similar to other studies [28][29][30][31].…”