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Table 2 Univariable and multivariable analyses of factors associated with crude 30-day mortality in patients with ICU-acquired IC

From: Incidence and outcome of invasive candidiasis in intensive care units (ICUs) in Europe: results of the EUCANDICU project

Variable

Total of patients (%)

n = 330 (100)

Non-survivors (%)

n = 137 (42)

Survivors (%)

N = 193 (58)

Univariable analysis

Multivariable analysis*

OR (95% CI)

p

OR (95% CI)

p

Demographics

 Age in years, median (IQR)

66 (55–75)

68 (59–77)

64 (51–73)

1.03 (1.01–1.05)

0.001

1.04 (1.02–1.06)

< 0.001

 Male gender

198 (60)

84 (61)

114 (59)

1.10 (0.70–1.72)

0.681

  

Medical history

 Diabetes mellitus

73 (22)

34 (25)

39 (20)

1.30 (0.77–2.20)

0.321

  

 COPD

44 (13)

22 (16)

22 (11)

1.49 (0.79–2.81)

0.222

  

 End-stage chronic renal disease

59 (18)

35 (26)

24 (12)

2.42 (1.36–4.29)

0.003

1.82 (0.96–3.45)

0.068

 Severe hepatic failurea

29 (9)

18 (13)

11 (6)

2.50 (1.14–5.49)

0.022

3.25 (1.31–8.08)

0.011

 Solid tumor

94 (28)

40 (29)

54 (28)

1.06 (0.65–1.72)

0.809

  

 Hematological malignancy

16 (5)

5 (4)

11 (6)

0.63 (0.21–1.85)

0.397

  

 Solid organ transplant

18 (5)

5 (4)

13 (7)

0.52 (0.18–1.51)

0.231

  

 Steroid treatment

43 (13)

20 (15)

23 (12)

1.26 (0.66–2.41)

0.477

  

 Immunosuppressants other than steroids

30 (9)

13 (9)

17 (9)

1.09 (0.51–2.32)

0.832

  

 Age-adjusted Charlson score

6 (3–7)

6 (5–8)

5 (3–7)

1.16 (1.07–1.25)

< 0.001

  

Recent exposures (within 30 days)

 Previous abdominal surgery

174 (53)

65 (47)

109 (56)

0.70 (0.45–1.08)

0.106

  

 Previous antibacterial therapy

226 (68)

102 (74)

124 (64)

1.62 (1.00–2.63)

0.050

1.53 (0.89–2.64)

0.124

 Previous echinocandins

35 (11)

12 (9)

23 (12)

0.71 (0.34–1.48)

0.360

  

 Previous azoles

53 (16)

22 (16)

31 (16)

1.00 (0.55–1.82)

0.999

  

 Previous amphotericin B

5 (2)

4 (3)

1 (1)

5.77 (0.64–52.24)

0.119

  

Baseline variables**

 SOFA score, median (IQR)

9 (5–12)

10 (7–13)

7 (4–10)

1.16 (1.10–1.22)

< 0.001

1.11 (1.04–1.17)

0.001

 SAPS II score, median (IQR)

48 (35–64)

55 (40–72)

43 (31–56)

1.03 (1.02–1.04)

< 0.001

  

 Length of ICU stay in days (IQR)

8 (3–19)

9 (3–20)

8 (3–18)

1.00 (0.99–1.01)

0.469

  

 WBC (cells × 109/L), median (IQR)

13.6 (8.2–20.2)

13.2 (7.5–20.0)

13.9 (8.8–20.7)

0.99 (0.98–1.01)

0.497

  

 AKI§

157 (48)

81 (59)

76 (39)

2.23 (1.43–3.48)

< 0.001

  

Infection variables

 Type of IC

    

0.193

  

  IAC

97 (29)

34 (25)

63 (33)

(ref)

   

  Candidemia

215 (65)

97 (71)

118 (61)

1.52 (0.93–2.50)

   

  IAC plus candidemia

18 (5)

6 (4)

12 (6)

0.93 (0.32–2.69)

   

 Candida species

    

0.866

  

  Candida albicans

162 (49)

65 (47)

97 (50)

(ref)

   

  Non-Candida albicans§§

141 (43)

60 (40)

81 (42)

1.11 (0.70–1.75)

   

  Candida albicans plus non-Candida albicans§§§

27 (8)

12 (9)

15 (8)

1.19 (0.53–2.72)

   

 Presence of septic shockb

165 (50)

91 (66)

74 (38)

3.18 (2.01–5.03)

< 0.001

2.12 (1.24–3.63)

0.006

 Presence of endocarditis

8 (2)

3 (2)

5 (3)

0.84 (0.20–3.58)

0.816

  

 Fluconazole resistancec

66 (24)

28 (25)

38 (23)

1.01 (0.65–1.99)

0.665

  

Early treatment variables***

 Adequate source control within 24 hd

205 (62)

73 (53)

132 (68)

0.53 (0.34–0.83)

0.006

0.65 (0.39–1.07)

0.093

 Adequate empiric antifungals within 24 he

93 (36)

35 (36)

58 (36)

0.97 (0.57–1.63)

0.902

  
  1. Results are presented as n (%) unless otherwise indicated. AKI acute kidney injury, COPD chronic obstructive pulmonary disease, CVC central venous catheter, IC invasive candidiasis, IAC intra-abdominal candidiasis, ICU intensive care unit, IQR interquartile range, SAPS simplified acute physiology score, SOFA sequential organ failure assessment, WBC white blood cells
  2. *Only results for variables retained in the final multivariable model (model A) are presented. Variables included in model A were also included in an additional generalized linear multivariable mixed logistic regression model with center as a random intercept (model B; standard deviation of the random effect = 0.311; model β0 = −4.329), the results of which were in line with those of model A: age (OR 1.04, 95% CI 1.02–1.06, p < 0.001); end-stage chronic renal disease (OR 1.83, 95% IC 0.95–3.52, p 0.070), severe liver failure (OR 3.41, 95% CI 1.33–8.73, p 0.010); previous antibacterial therapy (OR 1.51, 95% CI 0.86–2.63, p 0.148); SOFA score (OR 1.11, 95% CI 1.04–1.18, p 0.001); septic shock (OR 2.09, 95% CI 1.21–3.62, p 0.008), adequate source control within 24 h (OR 0.64, 95% CI 0.38–1.08, p 0.095). The Akaike information criterion (AIC) values for model A and model B were 391.1 and 392.5, respectively
  3. **At the onset of signs and symptoms of IC
  4. ***The present exploratory model was not developed to comprehensively assess the overall impact of antifungal therapy and/or adequate source control (including those performed beyond 24 h after the onset of symptoms), which needs further dedicated investigation to be reliably evaluated
  5. §ClCr < 60 mL/min
  6. §§C. glabrata (n = 52), C. parapsilosis (n = 38), C. tropicalis (n = 18), C. krusei (n = 14), C. dubliniensis (n = 4), other species with lower frequency (n = 5), more than one non-Candida albicans spp. concomitantly (n = 10)
  7. §§§C. albicans plus C. glabrata (n = 16), C. albicans plus C. parapsilosis (n = 4), other combinations with lower frequency (n = 7)
  8. aSevere hepatic failure was defined as liver cirrhosis according to histology or in the presence of a clinical diagnosis supported by laboratory, endoscopy, and radiologic findings
  9. bSeptic shock was defined as hypotension not responding to fluid therapy and requiring vasoactive agents
  10. cInformation available (i.e., fluconazole tested) for 274/330 patients (83%)
  11. dSource control was considered adequate in the following cases: (i) not necessary, (ii) devices or foreign body removal, (iii) drainage of infected fluid collections, (iv) debridement of infected solid tissue, and (v) definitive measures to correct anatomic derangements resulting in ongoing microbial contamination
  12. eFrom the onset of signs and symptoms of IC. Empiric treatment was considered adequate when the infecting organism was ultimately shown to be susceptible to the empirically administered antifungal. This analysis was conducted in the subgroup of patients not receiving empirical antifungal or receiving empirical antifungals for treating Candida spp. for which susceptibility test results were subsequently available (257/330, 78%)
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