Problematic dichotomisation of risk for ICU-acquired invasive candidiasis: results using a risk predictive model to categorise three levels of risk from a multicentre prospective cohort of Australian ICU patients

Playford, E. Geoffrey, Lipman, Jeffrey, Jones, Michael, Lau, Anna F., Kabir, Masrura, Chen, Sharon C-A., Marriott, Deborah J., Seppelt, Ian, Gottlieb, Thomas, Cheung, Winston, Iredell, Jonathan R., McBryde, Emma S., and Sorrell, Tania C. (2016) Problematic dichotomisation of risk for ICU-acquired invasive candidiasis: results using a risk predictive model to categorise three levels of risk from a multicentre prospective cohort of Australian ICU patients. Clinical Infectious Diseases, 63 (11). ciw610. pp. 1463-1469.

[img] PDF (Accepted Version) - Accepted Version
Restricted to Repository staff only

[img] PDF (Published Version) - Published Version
Restricted to Repository staff only

View at Publisher Website: http://dx.doi.org/10.1093/cid/ciw610
 
12
6


Abstract

Background: Delayed antifungal therapy for invasive candidiasis (IC) contributes to poor outcomes. Predictive risk models may allow targeted antifungal prophylaxis to those at greatest risk.

Methods: A prospective cohort study of 6,685 consecutive non-neutropenic patients admitted to seven Australian ICUs ≥72 hours was performed. Clinical risk factors for IC occurring prior to and following ICU admission, colonisation with Candida spp on surveillance cultures from three sites assessed twice-weekly, and the occurrence of IC ≥72 hours following ICU admission or ≤72 hours following ICU discharge were measured. From these parameters, a risk predictive model for the development of ICU-acquired IC was then derived.

Results: Ninety-six patients (1.43%) developed ICU-acquired IC. A simple summation risk predictive model using the ten independently significant variables associated with IC demonstrated overall moderate accuracy (area under receiver operator curve, 0.81). No single threshold score could categorise patients into clinically useful high- and low-risk groups. However, using two threshold scores, three patient cohorts could be identified; those at high risk (score ≥6, 4.8% of total cohort, positive predictive value, 11.7%), those at low risk (score ≤2, 43.1%, 0.24%), and those at intermediate risk (score 3-5, 52.1%, 1.46%).

Conclusions: Dichotomisation of ICU patients into high- and low-risk groups for IC risk is problematic. Categorising patients into high, intermediate, and low risk groups may more efficiently target early antifungal strategies and utilisation of newer diagnostic tests.

Item ID: 45776
Item Type: Article (Research - C1)
ISSN: 1537-6591
Funders: National Health and Medical Research Council of Australia (NHMRC), Centre for Research Excellence (CRE), Australian Universities Postgraduate Award, Pfizer Pharmaceuticals, Sydney Medical Foundation (SMF)
Projects and Grants: NHMRC Project Grant 512307, CRE Grant 264625
Date Deposited: 22 Sep 2016 02:57
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111706 Epidemiology @ 50%
16 STUDIES IN HUMAN SOCIETY > 1605 Policy and Administration > 160508 Health Policy @ 50%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920207 Health Policy Evaluation @ 100%
Downloads: Total: 6
More Statistics

Actions (Repository Staff Only)

Item Control Page Item Control Page