Risk Factors of Mortality in Older Patients With Candidemia

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Geriatric Medicine

Background:

• Candidemia presents a significant threat, especially to older adults, with limited research on mortality factors in this demographic.
• Understanding specific risk factors is crucial for improving outcomes in elderly patients experiencing this invasive fungal infection.

Purpose of the Study:

• To identify risk factors for in-hospital mortality in older patients diagnosed with candidemia.
• To compare mortality risk factors between older (>65 years) and younger candidemia patients.
• To evaluate the impact of early antifungal therapy on survival rates across different age groups.

Main Methods:

• Retrospective analysis of the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database.
• Inclusion of patients diagnosed with candidemia, comparing clinical characteristics and outcomes based on age (≤65 vs. >65 years).
• Assessment of the association between early antifungal administration and patient survival.

Main Results:

• Advanced age, congestive heart failure, cardiac arrhythmia, smoking, leukocytosis, and thrombocytopenia were linked to higher mortality in candidemia patients.
• Early antifungal therapy correlated with improved survival across all age groups.
• Older deceased patients showed higher rates of heart failure, pulmonary vascular diseases, and smoking; younger deceased patients had more metastatic cancer, coagulopathy, and cardiac arrhythmia.

Conclusions:

• Older patients with candidemia exhibit increased in-hospital mortality compared to younger counterparts.
• Thrombocytopenia emerged as an independent predictor of mortality.
• Prompt diagnosis and timely antifungal intervention are critical for reducing candidemia-related mortality.