Investigation of clinical characteristics and the role of C-reactive protein/albumin ratios in predicting mortality in patients with candidemia in the internal medicine intensive care unit

Candida species are the most common cause of fungal infections in patients treated in intensive care units and result in significant morbidity and mortality. The C-Reactive Protein (CRP)/albumin ratio has frequently been used as a parameter for predicting poor prognosis and mortality in patients followed in intensive care units in recent years. This study investigated the clinical characteristics, mortality rates, and the role of CRP/albumin ratios in predicting mortality in patients with candidemia detected in the Internal Medicine Intensive Care Unit (IM-ICU). Clinical and laboratory data of patients who were followed in the IM-ICU between January 1, 2017, and May 31, 2024, and had culture-confirmed candidemia were retrospectively analyzed. Patients' demographic data, primary diagnoses, chronic diseases, surgical history, catheter presence, immunosuppression status, and nutritional information were recorded. Laboratory data including biochemical parameters, CRP/albumin ratios, and complete blood count parameters were evaluated. In the evaluation of patients regarding 28-day mortality, pneumonia diagnosis was found to be an independent risk factor (p=0.022). Delayed initiation of antifungal treatment was associated with high mortality (p=0.013). The CRP/albumin ratio during candidemia was statistically significantly higher in patients who developed mortality (58.64±41.98) compared to those who did not mortality (38.90±29.31) (p=0.017). A CRP/albumin ratio>29.7 predicted 28-day mortality with 75% sensitivity and 50% specificity. All groups of antifungal agents significantly reduced mortality (p<0.05). The survival rate increased approximately 2.67-fold in patients receiving echinocandin therapy (p=0.018). Simultaneous or sequential echinocandin treatment with amphotericin B showed the strongest protective effect on 28-day mortality and increased the chance of survival by 5.21 times (p<0.001). The findings support that the CRP/albumin ratio can be used as a mortality predictor in candidemia patients. Close monitoring and early intervention should be planned for patients with CRP/albumin ratio>29.7.