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Terminal-stage prognostic analysis in candidemia
Takahiro Takuma1, Hisashi Shoji1, Yoshihito Niki1
1Department of Medicine, Division of Clinical Infectious Diseases, School of Medicine, Showa University, Tokyo, Japan.
Insights
Determining the cause of death in candidemia patients is complex. This study found that patient background and comorbidities, not just candidemia, significantly impact mortality, with delayed antifungal therapy linked to better survival outcomes.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- Candidemia presents a high mortality rate, yet its direct contribution to death is challenging to ascertain.
- Understanding factors influencing mortality in candidemia is crucial for effective patient management.
Purpose of the Study:
- To identify prognostic factors associated with mortality in patients diagnosed with culture-proven candidemia.
- To evaluate the impact of comorbid conditions and clinical prognostic stages on survival rates.
Main Methods:
- A cohort study was conducted at two Japanese university hospitals from April 2009 to May 2013.
- The Charlson comorbidity index and subjective clinical prognostic stages were assessed.
- Cox proportional hazard models were employed for univariate and multivariate survival analyses.
Main Results:
- Univariate analysis revealed increased mortality linked to internal medicine admission, Candida glabrata, immunosuppression, hypotension, hypoxemia, and terminal prognostic stage.
- Decreased mortality was associated with serum albumin, endophthalmitis investigation, and nonterminal prognostic stage.
- Multivariate analysis confirmed prognostic stage (P < 0.0001), age (P = 0.0014), and delayed antifungal therapy (P = 0.0374) as significant factors affecting survival.
Conclusions:
- Contrary to previous findings, delayed antifungal therapy was associated with decreased mortality in candidemia.
- Patient background and comorbidity status were more critical determinants of death than candidemia itself.
- Rigorous methodologies are essential for accurately determining causes of death in critically ill candidemia patients.
Background:
Candidemia has an extremely high mortality rate but is not always the direct cause of death. Therefore, determining the effect of candidemia on death is extremely difficult.
Methods:
We investigated prognostic factors in patients with culture-proven candidemia at 2 Japanese university teaching hospitals from April 2009 through May 2013. To examine the effects of comorbid conditions, the Charlson comorbidity index was determined, and patients were subjectively classified into 3 clinical prognostic stages (terminal [death expected within 1 month], semiterminal [death expected within 6 months], and nonterminal [expected to live more than 6 months]). The Cox proportional hazard model was used for univariate and multivariate analyses of factors possibly affecting survival.
Results:
On univariate analysis, factors identified as associated with an increased mortality rate were: admission to an internal medicine department, Candida glabrata, immunosuppression, hypotension, hypoxemia, and a terminal prognostic stage. Factors associated with a decreased mortality rate were: serum albumin, endophthalmitis investigation, and nonterminal prognostic stage. The mortality rate was significantly related to the prognostic stage on multivariate analysis (P < 0.0001), was increased by age (P = 0.0014), and was decreased by a delayed start of antifungal therapy (P = 0.0374).
Conclusion:
In contrast to earlier studies, the present study has found that later antifungal usage is associated with a decreased mortality rate in cases of candidemia. More important than candidemia in causing the deaths of patients with candidemia were the patients' background and comorbidity status. Therefore, rigorous methods should be used when investigating causes of death in terminally ill patients with candidemia.
