念珠菌血症患者的临床特点及预后因素

Clinical characteristics and influencing factors of prognosis of candidiasis

目的探讨念珠菌血症患者的临床特点及预后因素。方法收集福建省立医院2017年1月至2020年1月住院的念珠菌血症患者的资料,根据预后将患者分为好转组和恶化组,采用多因素logistic回归明确影响患者预后的独立危险因素,受试者工作特征曲线评估血尿素氮与血清白蛋白比值(BUN/ALB)对预后的检验效能。结果共纳入74例念珠菌血症患者,男性56例,女性18例,中位年龄68岁,大部分来自重症监护病房(ICU),多数患者有基础疾病、手术史、应用抗生素及侵入性操作。白色念珠菌为最主要病原菌,其次为光滑念珠菌、近平滑念珠菌等。多因素logistic回归分析显示高BUN/ALB、合并细菌性血流感染与疾病恶化的风险增加独立相关。BUN/ALB评价念珠菌血症预后的受试者工作特征曲线下面积为0.689,最佳截断值为0.42,敏感度为63.6%,特异度为76.7%。结论念珠菌血症患者多数有ICU住院史、基础病、多种抗生素使用、手术及侵入性操作史,高BUN/ALB、合并细菌性血流感染与死亡风险增加独立相关。

Objective To investigate the clinical characteristics and influencing factors of prognosis of Candidiasis.Methods The medical records of patients with candidemia hospitalized in Fujian provincial hospital from January 2017 to January 2020 were collected,and patients were divided into improvement and deterioration groups according to their prognosis.Multivariate logistic regression was used to identify the independent risk factors for patients′prognosis.The efficacy of BUN/ALB for prognosis was evaluated by receiver operating characteristic curve.Results A total of 74 patients with candidemia were enrolled,including 56 males and 18 females,with a median age of 68 years,most from the intensive care unit.Most patients had underlying diseases,a history of surgery or invasive procedures,and application of generally broad-spectrum antibiotics.Candida albicans was the most frequently isolated pathogen,followed by Candida glabrata,Candida parapsilosi,et al.Multivariate logistic regression analysis showed that high BUN/ALB and combined with bacterial bloodstream infection were independently correlated with the increased risk of disease deterioration.The area under the receiver operating characteristic curve for BUN/ALB evaluating the prognosis was 0.689,and the best cut-off value was 0.42,with a sensitivity of 63.6%and a specificity of 76.7%.Conclusion Patients with candidemia are critically ill and have a poor prognosis.Most patients have a history of intensive care unit hospitalization,underlying diseases,multiple antibiotics treatment,surgery and invasive procedures.High BUN/ALB and combined with bacterial bloodstream infection are independently correlated with the increased risk of disease deterioration.