Risk factors of septic shock development and thirty-day mortality with a predictive model in adult candidemia patients in intensive care units

Abstract

Background

This study aimed to investigate factors associated with septic shock development and 30-day mortality outcome with a prediction model among adult candidemia patients in the intensive care unit (ICU).

Methods

A retrospective study was conducted among patients admitted to the ICU from 2009 to 2018 at a tertiary care medical centre. The study subjects included adult patients ≥ 19 years with candidemia treated with antifungal agent for ≥ 3 days. Clinical variables were collected and analysed.

Results

A total of 126 patients were included in the study. Of these patients, 32 patients (25.4%) had septic shock. Multivariate logistic regression analysis revealed that chronic liver disease was associated with septic shock (odds ratio [OR] 3.372, 95% confidence interval [CI] 1.057 − 10.057). The rate of 30-day mortality was 35.7% and the associated mortality risk factors were malignancy (OR 8.251, 95% CI 2.227 − 30.573), chronic liver disease (OR 3.605, 95% CI 0.913 − 14.227), haemodialysis (OR 8.479, 95% CI 1.801 − 39.924), mycological failure (OR 29.675, 95% CI 7.012 − 125.578), and septic shock (OR 3.980, 95% CI 1.238 − 12.796). A predictive model for 30-day mortality was created based on the mortality risk factor scores, which had an area of 0.862 under the receiver operating characteristic curve.

Conclusions

Adult candidemia patients in the ICU who have chronic liver disease may be at higher risk of developing septic shock. Furthermore, our predictive model for 30-day mortality based on the mortality risk factors may be useful for clinical assessment.

Keywords:

• Candidemia
• septic shock
• mortality
• intensive care unit
• risk factor
• predictive model

Ethics approval and consent to participate

This study was approved by the institutional review board at the Korea University Anam Hospital (IRB Number 2018AN0440).

Consent for publication

Not applicable

Author contributions

JH Kim and JW Suh designed the study. All authors contributed to collection of data. JW Suh and JH Kim performed the analysis. The manuscript was drafted by JW Suh, and JH Kim revised the manuscript. All authors reviewed and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Availability of data and materials

The datasets used during the current study are available from the corresponding author on reasonable request.