Prediction of invasive candidal infection in critically ill patients with severe acute pancreatitis

Introduction

Patients with severe acute pancreatitis are at risk of candidal infectionscarrying the potential risk of an increase in mortality. Since early diagnosis isproblematic, several clinical risk scores have been developed to identify patientsat risk. Such patients may benefit from prophylactic antifungal therapy whilethose patients who have a low risk of infection may not benefit and may be harmed.The aim of this study was to assess the validity and discrimination of existingrisk scores for invasive candidal infections in patients with severe acutepancreatitis.

Methods

Patients admitted with severe acute pancreatitis to the intensive care unit wereanalysed. Outcomes and risk factors of admissions with and without candidalinfection were compared. Accuracy and discrimination of three existing risk scoresfor the development of invasive candidal infection (Candida score, CandidaColonisation Index Score and the Invasive Candidiasis Score) were assessed.

Results

A total of 101 patients were identified from 2003 to 2011 and 18 (17.8%) of thesedeveloped candidal infection. Thirty patients died, giving an overall hospitalmortality of 29.7%. Hospital mortality was significantly higher in patients withcandidal infection (55.6% compared to 24.1%, P = 0.02). Candidacolonisation was associated with subsequent candidal infection onmultivariate analysis. The Candida Colonisation Index Score was the most accuratetest, with specificity of 0.79 (95% confidence interval [CI] 0.68 to 0.88),sensitivity of 0.67 (95% CI 0.41 to 0.87), negative predictive value of 0.91 (95%CI 0.82 to 0.97) and a positive likelihood ratio of 3.2 (95% CI 1.9 to 5.5). TheCandida Colonisation Index Score showed the best discrimination with area underthe receiver operating characteristic curve of 0.79 (95% CI 0.69 to 0.87).

Conclusions

In this study the Candida Colonisation Index Score was the most accurate anddiscriminative test at identifying which patients with severe acute pancreatitisare at risk of developing candidal infection. However its low sensitivity maylimit its clinical usefulness.