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External Validation of Risk Prediction Scores for Invasive Candidiasis in a Medical/Surgical Intensive Care Unit: An
Armin Ahmed1, Arvind Kumar Baronia1, Afzal Azim1
1Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Background:
The aim of this study was to conduct external validation of risk prediction scores for invasive candidiasis.
Methods:
We conducted a prospective observational study in a 12-bedded adult medical/surgical Intensive Care Unit (ICU) to evaluate Candida score >3, colonization index (CI) >0.5, corrected CI >0.4 (CCI), and Ostrosky's clinical prediction rule (CPR). Patients' characteristics and risk factors for invasive candidiasis were noted. Patients were divided into two groups; invasive candidiasis and no-invasive candidiasis.
Results:
Of 198 patients, 17 developed invasive candidiasis. Discriminatory power (area under receiver operator curve [AUROC]) for Candida score, CI, CCI, and CPR were 0.66, 0.67, 0.63, and 0.62, respectively. A large number of patients in the no-invasive candidiasis group (114 out of 181) were exposed to antifungal agents during their stay in ICU. Subgroup analysis was carried out after excluding such patients from no-invasive candidiasis group. AUROC of Candida score, CI, CCI, and CPR were 0.7, 0.7, 0.65, and 0.72, respectively, and positive predictive values (PPVs) were in the range of 25%-47%, along with negative predictive values (NPVs) in the range of 84%-96% in the subgroup analysis.
Conclusion:
Currently available risk prediction scores have good NPV but poor PPV. They are useful for selecting patients who are not likely to benefit from antifungal therapy.
Insights
Risk prediction scores for invasive candidiasis show good negative predictive values but poor positive predictive values. These scores can help identify patients unlikely to benefit from antifungal therapy.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Medical Informatics
Background:
- Invasive candidiasis is a serious ICU-associated infection.
- Accurate risk prediction is crucial for timely and appropriate antifungal treatment.
- Existing risk prediction scores require external validation in diverse clinical settings.
Purpose of the Study:
- To externally validate the performance of four risk prediction scores for invasive candidiasis.
- To assess the accuracy of the Candida score, colonization index (CI), corrected colonization index (CCI), and Ostrosky's clinical prediction rule (CPR).
Main Methods:
- Prospective observational study in a 12-bedded adult medical/surgical Intensive Care Unit (ICU).
- Evaluation of Candida score (>3), CI (>0.5), CCI (>0.4), and CPR.
- Patients categorized into invasive candidiasis and no-invasive candidiasis groups.
- Subgroup analysis excluding patients exposed to antifungals.
Main Results:
- 17 out of 198 patients developed invasive candidiasis.
- Initial AUROCs ranged from 0.62 to 0.67.
- After excluding patients exposed to antifungals, AUROCs improved (0.65-0.72).
- Positive predictive values (PPVs) were 25%-47%, and negative predictive values (NPVs) were 84%-96% in subgroup analysis.
Conclusions:
- Current risk prediction scores for invasive candidiasis demonstrate high NPV but low PPV.
- These scores are valuable for identifying patients unlikely to require antifungal therapy.
- Further refinement of prediction models may be necessary to improve PPV.
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