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Clinical Utility of the Paed-EQUAL Candida Score in Paediatric Candidemia: A Real-World Cohort Study
Kubra Aykac1, Ilgın Sirin2, Turgut Ozdemir2
1Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Türkiye.
Insights
The Paed-EQUAL Candida Score shows limited ability to predict mortality in pediatric candidemia. Central venous catheter removal significantly improves survival, highlighting its importance in patient care.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Critical Care Medicine
Background:
- The Paed-EQUAL Candida Score assesses guideline adherence in pediatric candidemia.
- Its clinical utility in predicting outcomes in children is not well-established.
- Validation data for this score in pediatric populations are scarce.
Purpose of the Study:
- To evaluate the clinical utility of the Paed-EQUAL Candida Score.
- To assess its ability to predict mortality in pediatric candidemia.
- To explore optimal cut-off values for predicting outcomes.
Main Methods:
- Retrospective observational study of 127 pediatric patients with candidemia (2014-2024).
- Paed-EQUAL Candida Score calculated for each patient.
- Association with 30-day and 90-day mortality analyzed using ROC curve analysis.
Main Results:
- 13.4% and 21.3% of patients died within 30 and 90 days, respectively.
- Central venous catheter removal was linked to improved survival (p<0.01).
- The score showed modest discriminative ability for 30-day mortality (AUC 0.667) but not 90-day mortality.
Conclusions:
- The Paed-EQUAL Candida Score has limited prognostic performance in pediatric candidemia.
- Its ability to support clinical decision-making is constrained by modest discriminative capacity.
- Further development of pediatric-specific, outcome-oriented scoring systems is needed for improved risk stratification.
Background:
The Paed-EQUAL Candida Score was developed to assess adherence to guideline-recommended management in paediatric candidemia; however, its clinical utility in predicting outcomes remains unclear, particularly in paediatric populations where validation data are scarce.
Methods:
We conducted a retrospective observational study including paediatric patients diagnosed with candidemia at a tertiary-care centre between 2014 and 2024. The Paed-EQUAL Candida Score was calculated for each patient, and its association with 30-day and 90-day mortality was evaluated using ROC curve analysis, and optimal cut-off values were explored.
Results:
A total of 127 paediatric patients with candidemia were included, of whom 17 (13.4%) died within 30 days and 27 (21.3%) within 90 days. Central venous catheter removal was significantly associated with improved survival at both 30 days (76.4% vs. 35.3%, p = 0.001) and 90 days (77% vs. 48.1%, p = 0.007). Higher adherence to Paed-EQUAL Candida Score components was observed among survivors, with significantly higher median scores in survivors compared to non-survivors at 30 days (17 [IQR 14-18] vs. 14 [12-16], p = 0.026). However, the score indicated modest discriminative ability for predicting mortality, with an AUC of 0.667 (95% CI 0.577-0.748) for 30-day mortality and no significant predictive value for 90-day mortality (AUC 0.594, 95% CI 0.503-0.680).
Conclusion:
The Paed-EQUAL Candida Score demonstrated limited prognostic performance in paediatric candidemia and may have constraints in its ability to support clinical decision-making, particularly given its modest discriminative capacity. While it remains a potentially useful tool for assessing adherence to quality-of-care measures, further refinement or development of paediatric-specific and outcome-oriented scoring systems may be needed to improve risk stratification and prediction of clinical outcomes.