International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2025
Prognostic stratification in cancer candidemia under routine infectious disease consultation: Palliative Prognostic Index identifies patients with favorable short-term outcomes.
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Sekiya Noritaka, Okamoto Koh, Fukushima Kazuaki, Hosoda Tomohiro, Takahashi Kunihiko, Gu Yoshiaki
Аннотация
OBJECTIVES: Although consultations with infectious disease physicians (IDC) improve adherence to guidelines and reduce mortality in candidemia, data on mortality risk during routine IDC are scarce, especially in cancer patients.
METHODS: This retrospective cohort study included cancer patients with candidemia between January 2013 and December 2023 at a Japanese cancer center and assessed the European Confederation of Medical Mycology Quality of Clinical Candidaemia Management (EQUAL) score and factors associated with 30-day mortality during routine IDC using Firth's penalized likelihood logistic regression.
RESULTS: Of 227 patients with candidemia, 197 were included in the final analysis. Most cases were hospital-acquired (91%), and the 30-day mortality was 28%. Solid tumors (78%) and central venous catheter placement (82%) were common. The most frequent species were Candida albicans (37%), C. parapsilosis (23%), and C. glabrata (20%). The median EQUAL score with and without CVC placement was 22 (interquartile range [IQR]: 20-22) and 19 (IQR: 17-19), respectively. Factors associated with 30-day mortality were the Palliative Prognostic Index (PPI) score (adjusted odds ratio [aOR]: 14.64; 95% confidence interval [CI]: 6.21-38.51; P < .001) and the EQUAL score (aOR: 0.019; 95%CI: 0.003-0.073; P < .001). These findings were consistent in patients with solid tumors. Patients with a low PPI score (< 4) had a 30-day mortality of 10.9%.
CONCLUSIONS: The PPI score before candidemia onset independently predicted mortality during routine IDC in cancer patients. These results highlight IDC mortality benefits stratified by PPI and may stimulate discussion about ID's role in end-of-life cancer care practice.
METHODS: This retrospective cohort study included cancer patients with candidemia between January 2013 and December 2023 at a Japanese cancer center and assessed the European Confederation of Medical Mycology Quality of Clinical Candidaemia Management (EQUAL) score and factors associated with 30-day mortality during routine IDC using Firth's penalized likelihood logistic regression.
RESULTS: Of 227 patients with candidemia, 197 were included in the final analysis. Most cases were hospital-acquired (91%), and the 30-day mortality was 28%. Solid tumors (78%) and central venous catheter placement (82%) were common. The most frequent species were Candida albicans (37%), C. parapsilosis (23%), and C. glabrata (20%). The median EQUAL score with and without CVC placement was 22 (interquartile range [IQR]: 20-22) and 19 (IQR: 17-19), respectively. Factors associated with 30-day mortality were the Palliative Prognostic Index (PPI) score (adjusted odds ratio [aOR]: 14.64; 95% confidence interval [CI]: 6.21-38.51; P < .001) and the EQUAL score (aOR: 0.019; 95%CI: 0.003-0.073; P < .001). These findings were consistent in patients with solid tumors. Patients with a low PPI score (< 4) had a 30-day mortality of 10.9%.
CONCLUSIONS: The PPI score before candidemia onset independently predicted mortality during routine IDC in cancer patients. These results highlight IDC mortality benefits stratified by PPI and may stimulate discussion about ID's role in end-of-life cancer care practice.