title: Development and validation of a risk score for predicting invasive fungal infectious in an intensive care unit.
abstract: Delay in the initiation of appropriate antifungal therapy is associated with substantial morbidity and mortality. The aim of this study was to derive a risk score system for the development of invasive fungal infections in an intensive care unit (ICU). We retrospectively evaluated 1812 patients who stayed in the ICU for > or = 4 days, used univariate and multivariable logistic regression to identify potential risk factors associated with invasive fungal infections (IFI), and created a risk score system. Seven variables were identified as important predictors of ICU-IFI (diabetes mellitus, gastrointestinal surgery, hematological malignancies, mechanical ventilation > or = 2 days, central venous catheter, total parenteral nutrition, broad-spectrum antibiotic use > or = 4 days). The area under the receiver operating characteristic curve was 0.807 and was similar in the validation set. The percentages of patients with ICU-IFI in the low, intermediate, and high risk groups were 5.2%, 31.6%, and 63.2% in the derivation cohort and 4.2%, 30.1%, and 66.7% in the validation cohort, respectively. A new risk score was developed to predict ICU-IFI and was validated in an independent cohort. The new risk score may help clinicians identify patients who are at high risk of developing ICU-IFI and increase their odds of survival.
authors.affiliation: Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Liao
authors.forename: Ming-Kang
authors.initials: MK
authors.lastname: Zhong
authors.forename: Hong-Bin
authors.initials: HB
authors.lastname: Xu
authors.forename: Ling
authors.initials: L
authors.lastname: Li
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003428:Cross Infection / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009181:Mycoses / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013534:Survival
chemical_list: D000935:Antifungal Agents