Related Experiment Video
Updated: May 21, 2026
Inverse Probability of Treatment Weighting (Propensity Score) using the Military Health System Data Repository and National Death Index
Published on: January 8, 2020
Assessment of candidemia-attributable mortality in critically ill patients using propensity score matching analysis
Introduction:
Candidemia in critically ill patients is usually a severe and life-threatening condition with a high crude mortality. Very few studies have focused on the impact of candidemia on ICU patient outcome and attributable mortality still remains controversial. This study was carried out to determine the attributable mortality of ICU-acquired candidemia in critically ill patients using propensity score matching analysis.
Methods:
A prospective observational study was conducted of all consecutive non-neutropenic adult patients admitted for at least seven days to 36 ICUs in Spain, France, and Argentina between April 2006 and June 2007. The probability of developing candidemia was estimated using a multivariate logistic regression model. Each patient with ICU-acquired candidemia was matched with two control patients with the nearest available Mahalanobis metric matching within the calipers defined by the propensity score. Standardized differences tests (SDT) for each variable before and after matching were calculated. Attributable mortality was determined by a modified Poisson regression model adjusted by those variables that still presented certain misalignments defined as a SDT > 10%.
Results:
Thirty-eight candidemias were diagnosed in 1,107 patients (34.3 episodes/1,000 ICU patients). Patients with and without candidemia had an ICU crude mortality of 52.6% versus 20.6% (P < 0.001) and a crude hospital mortality of 55.3% versus 29.6% (P = 0.01), respectively. In the propensity matched analysis, the corresponding figures were 51.4% versus 37.1% (P = 0.222) and 54.3% versus 50% (P = 0.680). After controlling residual confusion by the Poisson regression model, the relative risk (RR) of ICU- and hospital-attributable mortality from candidemia was RR 1.298 (95% confidence interval (CI) 0.88 to 1.98) and RR 1.096 (95% CI 0.68 to 1.69), respectively.
Conclusions:
ICU-acquired candidemia in critically ill patients is not associated with an increase in either ICU or hospital mortality.
Insights
ICU-acquired candidemia in critically ill patients does not increase ICU or hospital mortality. This study used propensity score matching to analyze outcomes in intensive care unit patients with candidemia.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Epidemiology
Background:
- Candidemia in critically ill patients is a severe condition with high mortality.
- The impact of candidemia on intensive care unit (ICU) patient outcomes and attributable mortality remains debated.
- This study aimed to determine the attributable mortality of ICU-acquired candidemia.
Purpose of the Study:
- To assess the attributable mortality associated with candidemia in critically ill patients.
- To investigate the impact of ICU-acquired candidemia on patient outcomes.
- To utilize propensity score matching for robust analysis of candidemia's effects.
Main Methods:
- Prospective observational study in 36 ICUs across Spain, France, and Argentina.
- Inclusion of non-neutropenic adult patients admitted for at least seven days.
- Propensity score matching (Mahalanobis metric) and modified Poisson regression for mortality analysis.
Main Results:
- 38 cases of candidemia in 1,107 patients (34.3 episodes/1,000 ICU patients).
- Crude ICU mortality: 52.6% with candidemia vs. 20.6% without (P < 0.001).
- Propensity matched analysis showed no significant difference in ICU or hospital mortality between groups.
Conclusions:
- ICU-acquired candidemia in critically ill patients is not associated with increased ICU mortality.
- ICU-acquired candidemia in critically ill patients is not associated with increased hospital mortality.
- Findings suggest candidemia may not be an independent predictor of mortality in this population.
Related Concept Videos
01:24Kaplan-Meier Approach
01:20Comparing the Survival Analysis of Two or More Groups