Evaluation of clinical scores used in the diagnosis of candidemia in the intensive care unit

Aim: This study aimed to evaluate 3 different clinical scores in intensive care unit (ICU) patients with candidemia. These scoring systems were determined as the Ostrosky-Zeichner predictive rule, Nebraska Medical Center (NMC) and Cerrahpaşa Candida Score. The objective was to find the scoring that best predicts candidemia in ICU patients and to decrease morbidity and mortality rates by early diagnosis and treatment. Material and metod: In this retrospective case control study, ICU patients who developed and did not develop candidemia and were followed in our hospital between January 2021 and December 2023 were included by matching at a ratio of 1:3. Neutropenic, pregnant, transplanted, HIV (Human Immunodeficiency Virus) infected patients and cases younger than 18 years of age were not included in the study. The patients' demographic data and candidemia risk factors were examined. After all data was evaluated, the Cerrahpaşa Candida Score, NMC and Ostrosky-Zeichner risk scores were calculated for each patient. Results: A total of 159 patients were included to the study, with 40 in the candidemia group and 119 in the control group. Sixty percent of the candidemia group were women and the average age was 68 years. There was no significant difference in gender and age distribution between the candidemia and control groups. In the candidemia group, 27,5% of the isolated species were C. albicans, 25% were C.glabrata and 15% C.tropicalis. The presence of central vein catheter on the day of candidemia, extended antibiotic use on the day of candidemia, immunosuppression, intra-abdominal infection, acute renal injury, severe sepsis, candida colonisation, Cerrahpaşa Candida score ≥4 and risk existence according to the Ostrosky-Zeichner rule were found to be significantly higher in the candidemia group. The Cerrahpaşa Candida score had a specificity of 93,3%, positive predictive value of 69,2%, a negative predictive value of 83,5%, an accuracy rate of 80,1% and was found to predict candidemia at a significantly higher level compared to other scores. Conclusion : Cerrahpaşa Candida score has high positive and negative predictive value and an accuracy rate compare to the other scores. Furthermore, its daily calculation function enables it to dynamically predict the risk of candidemia in ICU patients. In this regard, early diagnosis and empirical treatment can reduce the morbidity and mortality related to candidemia. Keywords: Candidemia, Intensive Care Unit, Cerrahpaşa Candida Score