Author:
Carelli Simone,Posteraro Brunella,Torelli Riccardo,De Carolis Elena,Vallecoccia Maria Sole,Xhemalaj Rikardo,Cutuli Salvatore Lucio,Tanzarella Eloisa Sofia,Dell’Anna Antonio Maria,Lombardi Gianmarco,Cammarota Fabiola,Caroli Alessandro,Grieco Domenico Luca,Sanguinetti Maurizio,Antonelli Massimo,De Pascale Gennaro
Abstract
Abstract
Background
To determine whether a decrease in serum (1,3)-β-d-glucan (BDG) was associated with reduced mortality and to investigate the performance of BDG downslope in predicting clinical outcome in invasive candidiasis.
Methods
Observational cohort study in ICU patients over a ten-year period (2012–2022) in Italy. Proven invasive candidiasis with at least 2 BDG determinations were considered.
Results
In the study population of 103 patients (age 47 [35–62] years, SAPS II score 67 [52–77]) 68 bloodstream and 35 intrabdominal infections were recorded. Serial measurements showed that in 54 patients BDG decreased over time (BDG downslope group) while in 49 did not (N-BDG downslope group). Candida albicans was the pathogen most frequently isolated (61%) followed by C. parapsilosis (17%) and C. glabrata (12%), in absence of any inter-group difference. Invasive candidiasis related mortality was lower in BDG downslope than in N-BDG downslope group (17% vs 53%, p < 0.01). The multivariate Cox regression analysis showed the association of septic shock at infection occurrence and chronic liver disease with invasive candidiasis mortality (HR [95% CI] 3.24 [1.25–8.44] p = 0.02 and 7.27 [2.33–22.66] p < 0.01, respectively) while a BDG downslope was the only predictor of survival (HR [95% CI] 0.19 [0.09–0.43] p < 0.01). The area under the receiver operator characteristic curve for the performance of BDG downslope as predictor of good clinical outcome was 0.74 (p = 0.02) and our model showed that a BDG downslope > 70% predicted survival with both specificity and positive predictive value of 100%.
Conclusions
A decrease in serum BDG was associated with reduced mortality and a steep downslope predicted survival with high specificity in invasive candidiasis.
Publisher
Springer Science and Business Media LLC
Cited by
1 articles.
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1. Quarterly Roundup of Notable Articles (June and July 2024);Journal of Clinical Infectious Disease Society;2024-07