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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%)