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. 2023 Feb;66(2):128-137.
doi: 10.1111/myc.13531. Epub 2022 Sep 26.

Development and validation of COVID-19 associated candidemia score (CAC-Score) in ICU patients

Bircan Kayaaslan  1 , Fatma Eser  1 , Dilek Asilturk  2 , Zeynep Oktay  2 , Imran Hasanoglu  1 , Ayşe Kaya Kalem  1 , Gülen Dönertaş  2 , Betul Kaplan  2 , Isıl Ozkocak Turan  3 , Deniz Erdem  3 , Hesna Bektas  4 , Rahmet Guner  1
Affiliations

Development and validation of COVID-19 associated candidemia score (CAC-Score) in ICU patients

Bircan Kayaaslan et al. Mycoses. 2023 Feb.

Abstract

Background: The development of candidemia is a highly fatal condition in severe COVID-19 infection.

Objectives: This study aimed to develop a candidemia prediction score in COVID-19 patient based on the patient's clinical characteristics, and healthcare-related factors during intensive care units (ICU) follow-up.

Patients/methods: Severe COVID-19 patients hospitalised in ICU in Ankara City Hospital during the one-year period (August 15, 2020, and August 15, 2021) were included. After univariate analysis, multivariate analysis was applied using variable selection approach to investigate the effects of variables together and to create a score model for candidemia. Statistically significant factors were included in the development process of candida prediction score.

Results: Of 1305 COVID-19 ICU patients, 139 had a candidemia episode. According to the final model, four variables, presence of central venous catheter (CVC) (OR 19.07, CI 8.12-44.8, p < .0001), multifocal colonisation (OR 2.28, CI 1.39-3.72, p 0.001), length of ICU stays ≥14 days (OR 3.62, CI 2.42-5.44, p < .0001) and corticosteroids (OR 0.51, CI 0.34-0.76, p 0.0011) were the only statistically significant independent risk factors for candidemia. Score model was demonstrated by a nomogram, and the risk for candidemia was calculated to be high in patients who scored ≥56 points by using the criteria [CVC = 51, multifocal colonisation = 14, prolonged hospitalisation = 23, no steroid use = 12 points]. The AUC of the score is 0.84 (CI 0.81-0.87).

Conclusion: We developed and validated an easy-to-use clinical prediction score for candidemia in severe COVID-19 infection. In COVID-19 ICU patients, the risk of candidemia is high if one of the other risk factors is present together with CVC.

Keywords: COVID-19; COVID-19 associated candidemia; candida; candidemia; risk factors; score.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Demonstration of score model by a nomogram
FIGURE 2
FIGURE 2
Performance of score for estimating the possibility of developing candidemia
FIGURE 3
FIGURE 3
Predictive calibration curve and ideal curve for estimating the candidemia
See this image and copyright information in PMC

References

    1. Ostrosky‐Zeichner L, Sable C, Sobel J, et al. Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting. Eur J Clin Microbiol Infect Dis. 2007;26(4):271‐276. - PubMed
    1. Rentz AM, Halpern MT, Bowden R. The impact of candidemia on length of hospital stay, outcome, and overall cost of illness. Clin Infect Dis. 1998;27(4):781‐788. - PubMed
    1. Epelbaum O, Chasan R. Candidemia in the intensive care unit. Clin Chest Med. 2017;38(3):493‐509. - PubMed
    1. Macauley P, Epelbaum O. Epidemiology and mycology of Candidaemia in non‐oncological medical intensive care unit patients in a tertiary center in the United States: overall analysis and comparison between non‐COVID‐19 and COVID‐19 cases. Mycoses. 2021;64(6):634‐640. - PMC - PubMed
    1. Kayaaslan B, Eser F, Kaya Kalem A, et al. Characteristics of candidemia in COVID‐19 patients; increased incidence, earlier occurrence and higher mortality rates compared to non‐COVID‐19 patients. Mycoses. 2021;64(9):1083‐1091. - PMC - PubMed