Predictive value of a modified Multi-disease Risk Assessment cutoff score for invasive fungal infection in ICU

Yuanyuan XU; Lin YE; Bailin NIU

doi:10.16016/j.1000-5404.201811138

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Predictive value of a modified Multi-disease Risk Assessment cutoff score for invasive fungal infection in ICU

Clinical Medicine | 更新时间：2026-01-09

- Predictive value of a modified Multi-disease Risk Assessment cutoff score for invasive fungal infection in ICU
- Journal of Third Military Medical University Vol. 41, Issue 10, Pages: 980-986(2019)
- 作者机构：
  
  重庆医科大学附属第一医院，急诊 & 重症医学科，重庆，400016
- 作者简介：
- 基金信息：
  
  National Clinical Key-discipline Construction Program(20170408);Snake College Research Fund for Critical Care Medicine(2017001);Cultivation Fund of the First Affiliated Hospital of Chongqing Medical University(PYJJ2017-26)
- DOI：10.16016/j.1000-5404.201811138
  CLC： R459.7;R519;R631
- Received：20 November 2018，
  
  Revised：2019-01-04，
  
  Published：30 May 2019
- 稿件说明：
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Yuanyuan XU, Lin YE, Bailin NIU. Predictive value of a modified Multi-disease Risk Assessment cutoff score for invasive fungal infection in ICU[J]. Journal of Third Military Medical University, 2019, 41(10): 980-986.
DOI：

Yuanyuan XU, Lin YE, Bailin NIU. Predictive value of a modified Multi-disease Risk Assessment cutoff score for invasive fungal infection in ICU[J]. Journal of Third Military Medical University, 2019, 41(10): 980-986. DOI： 10.16016/j.1000-5404.201811138.

摘要

目的

分析修正性MDRA评分对ICU内患者侵袭性真菌感染(invasive fungal infection

IFI)的预测价值。

方法

回顾性收集2016年7月至2018年6月本院ICU住院的具有侵袭性真菌感染高危因素患者的病例资料

分析原有MDRA评分系统对ICU侵袭性真菌感染的预测效能

并比较评价修正性MDRA评分在其临床干预时机选择中的效能。

结果

按原有MDRA≥30分标准筛选393例具有IFI高危因素的患者中MDRA≥30分有276人

后续确诊或临床诊断为IFI的患者有101人。通过统计分析

修正后以MDRA=36分为cut off值

诊断IFI的灵敏度为85.61%

特异度为89.38%

诊断效能较好。当MDRA≥36分

与未及时启动抗真菌治疗方案的患者(B

组76例)比较

24 h内启动抗真菌治疗方案的患者(A

组37例)病死率明显下降(

0.05)

且呼吸机使用时间及ICU住院时间明显缩短(

0.05)。

结论

修正的MDRA评分(MDRA≥36分)对ICU内IFI感染有较高的预测价值。

Abstract

Objective

To analyze the predictive value of a modified cutoff score of Multi-disease Risk Assessment (MDRA) for invasive fungal infection in patients admitted in the intensive care unit (ICU) and explore the optimal time window for intervention.

Methods

We retrospectively collected the clinical data of patients at high risk of invasive fungal infection

who were admitted in the ICU in our department between July

2016 and June

2018. We compared the predictive value of the original and the modified MDRA cutoff scores for invasive fungal infection in these patients.

Results

We screened a total of 393 high-risk patients

among whom 276 had MDRA scores above 30; 101 of the patients had a subsequent diagnosis or a clinical diagnosis of invasive fungal infections. After statistical analysis

we used a MDRA score of 36 as the cut-off value

which showed a sensitivity of 85.61% and a specificity of 89.38% for predicting invasive fungal infection. Among the patients with a

MDRA score ≥36

the patients who received antifungal therapy within 24

h (37 cases

Group A

) had a significantly reduced mortality (

0.05) with also shortened duration of ventilator use and ICU stay (

0.05) as compared with the 76 patients (Group B

) who did not receive antifungal therapy in time.

Conclusion

In patients admitted in ICU

a MDRA score ≥36 has a high predictive value for invasive fungal infection and is indicative of immediate interventions with antifungal drugs.

关键词

Keywords

references

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