Abstract:
Objective To investigate related factors for prognosis in elderly critically ill patients with septic shock caused by candidemia.
Methods Single center, retrospective and observational study, thirty-one non-neutropenic elderly septic shock patients caused by candidemia in intensive care unit (ICU) were enrolled. Levels of procalcitonin (PCT), C-reactive protein (CRP), white blood cell (WBC) count, blood lactic acid (LAC), sequential organ failure assessment (SOFA) score as well as acute physiology and chronic health evaluationⅡ (APACHEⅡ) score on 1st, 2nd, 3rd, 5th, 7th day after making a definite of diagnosis of septic shock caused by candidemia were collected. Patients were divided into survival group and death group according to 28-day mortality. Differences in parameters between two group were compared, and multiple logistic regression analysis was performed to identify the risk factors significantly associated with 28-day mortality.
Results During the study period (January 2010 to December 2014), 31 septic shock patients caused by candidemia episodes in ICU were enrolled, of whom 71% were identified as non-albicans candida and 29% were candida albicans. There were 16 patients in death group and 15 patients in survival group. APACHEⅡscore in death group was significantly higher than those in survival group at first day(27.63±5.14)vs. (22.60±5.88),P=0.017, and PCT in survival group was significantly higher than those in death group (2.74±2.32) vs. (1.45±1.01),P=0.045. PCT and APACHEⅡ score decreased in survival group with time dependency pattern after 3rd day. In addition, the results of effect analysis showed that there were significant differences in PCT and APACHEⅡ score between both groups (P<0.05). WBC, CRP, LAC, as well as SOFA score did not change significantly in both groups, and there were no significantly differences at each time point between both groups. Multivariable logistic regression analysis revealed that PCT (odds ratio 0.272, 95%CI 0.084~0.883, P=0.030) and APACHEⅡscore (odds ratio 1.349, 95%CI 1.052~1.731,P=0.018) were independently associated with 28-day mortality between two groups.
Conclusion Antifungal agents sensitive to non-albicans candida should be a priority to those elderly non-neutropenic septic shock patients caused by candidemia in ICU; PCT and APACHEⅡscores are independently associated with 28-day mortality for those patients; and greater clinical significance could be attained with dynamic observation and evaluation of both parameters.