Biochemical and haematologic predictors of fungemia in previous colonised ICU patients

Introduction

In last years the nosocomial ICU fungal infections are assuming a greater impact with increasing morbidity, mortality and cost. A better outcome is correlated with an earlier treatment.

Objectives

The aim of the study was to assess the accuracy of expensive biochemical and haematologic parameters to predict the change of fungal colonisation to a status of fungemia.

Materials and methods

Three-year retrospective study with 806 ICU medical and surgical non-neutropenic patients. The study group consisted of 90 patients with fungal documentation, 37 patients were excluded for insufficient data. We considered two groups.

Group 1 — colonisation 73 patients (fungal documentation in biological products except blood)

Group 2 — fungemia 17 patients (at least one positive blood culture)

Age, SAPSII in first 24 h, alkaline phosphatase, lactate dehydrogenase, blood lactate, pH, bicarbonate, leukocytes, and platelets were evaluated in all patients the 3 days preceding fungal documentation. We compared biochemical and haematologic results in group 1 and group 2 trying to identity a different profile and evaluated the predictive value of the different parameters. Results are presented as media and standard deviation. We applied t student test comparing the two groups and we considered a P < 0.05 to be significant.

Results

(See Table). We found significant statistical difference with bicarbonate, and platelet count when comparing the two groups. We also observed an increasing blood level on alkaline phosphate in fungemic patients.

Conclusion

In our study, variations on bicarbonate, platelet countand alkaline phosphatase are predictive of fungemia in previous colonised patients. However, further observations, analyses, are needed and perhaps involving larger patient numbers to evaluate the clinical utility of these findings.

Table 1