修正性MDRA评分对ICU侵袭性真菌感染患者的预测价值

徐媛媛; 叶林; 钮柏琳

doi:10.16016/j.1000-5404.201811138

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修正性MDRA评分对ICU侵袭性真菌感染患者的预测价值

临床医学 | 更新时间：2026-01-09

- 修正性MDRA评分对ICU侵袭性真菌感染患者的预测价值
- Predictive value of a modified Multi-disease Risk Assessment cutoff score for invasive fungal infection in ICU
- 第三军医大学学报 2019年41卷第10期页码：980-986
- 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：
  
  [ 钮柏琳，E-mail: nberlin@126.com NIU Bailin, E-mail: nberlin@126.com
- 基金信息：
  
  国家临床重点专科——重症医学科专科建设专项经费、重庆市渝中区科技计划项目(20170408);蛇牌学院重症科学研究基金(2017001);重庆医科大附属第一医院培育基金(PYJJ2017-26)
- DOI：10.16016/j.1000-5404.201811138
  中图分类号： R459.7;R519;R631
- 收稿：2018-11-20，
  
  修回：2019-01-04，
  
  纸质出版：2019-05-30
- 稿件说明：
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徐媛媛, 叶林, 钮柏琳. 修正性MDRA评分对ICU侵袭性真菌感染患者的预测价值[J]. 第三军医大学学报, 2019,41(10):980-986.

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.
徐媛媛, 叶林, 钮柏琳. 修正性MDRA评分对ICU侵袭性真菌感染患者的预测价值[J]. 第三军医大学学报, 2019,41(10):980-986. DOI： 10.16016/j.1000-5404.201811138.

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

PETOSA C, GOVIN J, MIETTON F. A new hope to fight invasive fungal infection[J]. Med Sci (Paris), 2018, 34(2): 123-125. DOI: 10.1051/medsci/20183402007.

HSU L Y, LEE D G, YEH S P, et al. Epidemiology of invasive fungal diseases among patients with haematological disorders in the Asia-Pacific: A prospective observational study[J]. Clin Microbiol Infect, 2015, 21(6): 594.e7-594.11. DOI: 10.1016/j.cmi.2015.02.019.

HALTMEIER T, INABA K, EFFRON Z, et al. Candida score as a predictor of worse outcomes and mortality in severely injured trauma patients with positive candida cultures[J]. Am Surg, 2015, 81(10): 1067-1073.

中华医学会重症医学分会.重症患者侵袭性真菌感染诊断与治疗指南(2007)[J].中华内科杂志, 2007, 23(11): 960-966.

Critical Care Branch of the Chinese Medical Association. Guidelines for the diagnosis and treatment of invasive fungal infection in intensive care units(2007)[J]. Chin J Intern Med, 2007, 23(11): 960-966.

郭凤梅, 杨毅, 邱海波.中国重症患者侵袭性念珠菌感染的流行病学特征[J].中华内科杂志, 2014, 53(6): 491-492. DOI: 10.3760/j.issn.0578-1426.2014.06.021.

GUO F M, YANG Y, QIU H B. Epidemiological characteristics of invasive candidiasis in intensive care units in China[J]. Chin J Intern Med, 2014, 53(6): 491-492. DOI: 10.3760/j.issn.0578-1426.2014.06.021.

THOMAS J C, MADIGAN M. A retrospective study to evaluate a computer based model for amplifying early antifungal intervention and microbial detection of patients at risk for fungemia[C].San Anto nio : Seventh Annual Focus on Fungal Infection, 1997.

曹江红, 李光辉.侵袭性真菌病修订定义——欧洲癌症研究和治疗组织/侵袭性真菌感染协作组和美国国立变态反应和感染病研究院真菌病研究组(EORTC/MSG)共识组[J].中国感染与化疗杂志, 2008, 8(5): 321-324.

CAO J H, LI G H. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group(EORTC/MSG) Co[J]. Chin J Infect Chemother, 2008, 8(5): 321-324.

SARAN P S, AZIM A. Risk factors for early invasive fungal disease in critically ill patients[J]. Indian J Crit Care Med, 2016, 20(11): 633-639. DOI: 10.4103/0972-5229.194007.

SINGARAVELU K, GÁCSER A, NOSANCHUK J D. Genetic determinants of virulence-Candida parapsilosis[J]. Revista Iberoamericana de Micología, 2014, 31(1): 16-21. DOI: 10.1016/j.riam.2013.09.018.

PARAMYTHIOTOU E, FRANTZESKAKI F, FLEVARI A, et al. Invasive fungal infections in the ICU: how to approach, how to treat[J]. Molecules, 2014, 19(1): 1085-1119. DOI: 10.3390/molecules19011085.

孟文晴, 陆璇, 潘正慧, 等. G试验和GM试验联合痰真菌培养对ICU患者侵袭性真菌感染的早期诊断[J].中国感染控制杂志, 2018, 17(1): 41-46. DOI: 10.3969/j.isn.1671-9638.2018.01.009.

MENG W Q, LU X, PAN Z H, et al. G test and GM test combined with sputum fungal culture for the early diagnosis of invasive fungal infection in intensive care unit patients[J]. Chin J Infec Control, 2018, 17(1): 41-46. DOI: 10.3969/j.isn.1671-9638.2018.01.009.

CEESAY M M, SADIQUE Z, HARRIS R, et al. Prospective evaluation of the cost of diagnosis and treatment of invasive fungal disease in a cohort of adult haematology patients in the UK[J]. J Antimicrob Chemother, 2015, 70(4): 1175-1181. DOI: 10.1093/jac/dku506.

SUN Y Q, MENG F Y, HAN M Z, et al. Epidemiology, management, and outcome of invasive fungal disease in patients undergoing hematopoietic stem cell transplantation in China: A multicenter prospective observational study[J]. Biol Blood Marrow Transplant, 2015, 21(6): 1117-1126. DOI: 10.1016/j.bbmt.2015.03.018.

FORTÚN J, CARRATALÁ J, GAVALDÁ J, et al. Guidelines for the treatment of invasive fungal disease by Aspergillus spp. and other fungi issued by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). 2011 Update[J]. Enferm Infect Microbiol Clin, 2011, 29(6): 435-454. DOI: 10.1016/j.eimc.2011.01.010.

MELLINGHOFF S C, HOENIGL M, KOEHLER P, et al. EQUAL candida score: An ECMM score derived from current guidelines to measure QUAlity of clinical candidaemia management[J]. Mycoses, 2018, 61(5): 326-330. DOI: 10.1111/myc.12746.

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