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VOLUME 21 , ISSUE 8 ( 2017 ) > List of Articles

RESEARCH ARTICLE

External validation of risk prediction scores for invasive candidiasis in a medical/surgical intensive care unit: An observational study

Arvind Kumar Baronia, Preeti Sharma, Reema Yadav, Rungmei S. K. Marak, Ratender Singh

Keywords : clinical prediction rule, colonization index, corrected colonization index, invasive candidiasis,Candida score

Citation Information : Baronia A K, Sharma P, Yadav R, Marak RS, Singh R. External validation of risk prediction scores for invasive candidiasis in a medical/surgical intensive care unit: An observational study. Indian J Crit Care Med 2017; 21 (8):514-520.

DOI: 10.4103/ijccm.IJCCM_33_17

License: CC BY-ND 3.0

Published Online: 00-08-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: The aim of this study was to conduct external validation of risk prediction scores for invasive candidiasis. Methods: We conducted a prospective observational study in a 12-bedded adult medical/surgical Intensive Care Unit (ICU) to evaluate Candida score >3, colonization index (CI) >0.5, corrected CI >0.4 (CCI), and Ostrosky\'s clinical prediction rule (CPR). Patients\' characteristics and risk factors for invasive candidiasis were noted. Patients were divided into two groups; invasive candidiasis and no-invasive candidiasis. Results: Of 198 patients, 17 developed invasive candidiasis. Discriminatory power (area under receiver operator curve [AUROC]) for Candida score, CI, CCI, and CPR were 0.66, 0.67, 0.63, and 0.62, respectively. A large number of patients in the no-invasive candidiasis group (114 out of 181) were exposed to antifungal agents during their stay in ICU. Subgroup analysis was carried out after excluding such patients from no-invasive candidiasis group. AUROC of Candida score, CI, CCI, and CPR were 0.7, 0.7, 0.65, and 0.72, respectively, and positive predictive values (PPVs) were in the range of 25%–47%, along with negative predictive values (NPVs) in the range of 84%–96% in the subgroup analysis. Conclusion: Currently available risk prediction scores have good NPV but poor PPV. They are useful for selecting patients who are not likely to benefit from antifungal therapy.


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