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Attributable Mortality to Candidiasis in Non-Neutropenic Critically Ill Patients in the ICU and a Post-Mortem Study
Jordi Ibañez-Nolla1,2, Felip Garcia3, Miquel A Carrasco4
1Health Sciences Faculty, Blanquerna-Universitat Ramon Llull, 08025 Barcelona, Spain.
Abstract:
Candidiasis remains one of the most challenging infections to treat in critical care, due to its diagnostic difficulties and uncertainty regarding whether it can be directly related to the death of patients with multiorgan failure. This study aims to verify that the statistically attributable mortality in this infection is as consistent as the post-mortem attributable mortality. A prospective study was conducted in non-neutropenic ICU patients in whom Candida was detected. Invasive candidiasis is defined based on evidence of disseminated or multifocal candidiasis. Post-mortem study is used as the gold standard for Candida-attributable mortality, and is compared with attributable mortality determined according to clinical study and statistically attributable mortality in relation to the overall mortality of ICU patients and colonized patients. The post-mortem attributable mortality was 30.6% and 22.6% according to the clinical study, while the statistically attributable mortality was 25% in relation to overall ICU mortality and 27% in relation to Candida colonization. Thus, the results of the different calculations of attributable mortality (statistical vs. crude death rate) due to Candida are in agreement. The use of this metric may help to improve ICU outcomes for non-neutropenic critically ill patients with candidiasis.
Insights
Determining mortality attributable to candidiasis in intensive care units (ICUs) is challenging. This study found that statistical methods align with post-mortem data, offering a reliable way to assess candidiasis-related deaths in critically ill patients.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pathology
Background:
- Candidiasis presents significant challenges in critical care settings, with difficulties in diagnosis and establishing direct causality to patient mortality.
- Uncertainty exists regarding the direct link between candidiasis and death in patients experiencing multiorgan failure.
Purpose of the Study:
- To validate the consistency of statistically attributable mortality for candidiasis against post-mortem attributable mortality.
- To assess the reliability of different mortality calculation methods for invasive candidiasis.
Main Methods:
- A prospective study involving non-neutropenic intensive care unit (ICU) patients with detected Candida.
- Invasive candidiasis was defined by evidence of disseminated or multifocal infection.
- Post-mortem studies served as the gold standard, compared with clinical and statistical mortality assessments.
Main Results:
- Post-mortem attributable mortality was 30.6%, while clinical study assessment yielded 22.6%.
- Statistically attributable mortality was 25% relative to overall ICU mortality and 27% relative to Candida colonization.
- Calculations for attributable mortality, whether statistical or crude death rate, showed agreement for Candida-related deaths.
Conclusions:
- Statistical and post-mortem methods for determining candidiasis-attributable mortality are consistent.
- Implementing these metrics can potentially enhance ICU outcomes for non-neutropenic critically ill patients with candidiasis.
