Values of different fungal infection risk scoring methods for the early diagnosis of invasive Candida infection

Abstract:

ObjectiveTo compare diagnostic value of four fungal scoring methods in invasive Candida infection, provide evidence for early diagnosis and treatment of invasive Candida infection. MethodsHighrisk patients with invasive Candida infection in the intensive care unit(ICU) in a hospital from 2011 to 2016 were analyzed retrospectively. According to diagnostic criteria, patients were divided into four groups: noninfection group, suspected infection group, clinically diagnosed group, and confirmed group, patients were conducted multidiseases risk assessment (MDRA) score, invasive fungal infections risk scoring system (IFIRSS ) score, Sevilla score, and Candida score, diagnostic value of four scoring methods for invasive Candida infection were evaluated. ResultsThere were 275 highrisk patients, 138 in noninfection group, 63 in suspected infection group, and 74 in infection group(clinically diagnosed group: n=64; confirmed group: n=10). The age and length of hospital stay in the infection group were all higher than noninfection group (both P<0.05). 74 strains of Candida were isolated from 74 infected patients, mainly Candida albicans (n=60, 81.1%). Positive rates for MDRA score, Candida score, Sevilla score, and IFIRSS score were 41.5%(n=114), 30.2%(n=83), 15.3%(n=42), and 8.4% (n=23) respectively. Of four MDRA scoring methods, MDRA had the higher sensitivity(Se, 59%) but lowest specificity(Sp, 66%); IFIRSS had higher Sp(91%) but very low Se (9%); Sevilla score had the highest Sp (96%）and higher Se(45%) ；Candida score had the highest Se（68%） and higher Sp (90%）. ConclusionSevilla score has higher Se and Sp, which can be used in early diagnosis of invasive Candida infection; Candida score has the highest coincidence with clinical diagnostic criteria for invasive Candida infection, both Se and Sp are high, which is of great value for early diagnosis of invasive Candida infection.