| Objective: The study is designed to assess the ability of Virginia score,Sevilla score and Candida score which identify patients with high risk of invasive candida infection in clinical application,and provide efective basis of clinical esrly diagnosis and treatment of invasive candida infection.Methods: 1. Retrospectively collecting clinical data of 106 patients with high risk of invasive candida infection(general information of the individual, prognosis, medical history, bacteriology related training, etc) treated in the ICU department of Ningxia medical university general hospital from January 2011 to December 2014.,taking "Severe invasive fungal infection in patients with the diagnosis and treatment guidelines" formulated in intensive medical branch of Chinese medical association in 2007 as diagnostic criteria, we divided the patients into proven,probable,possible and non-invasive candida infections four groups. 2.According to the standard of the fungal scoring system,marking the four groups of patients with Virginia score,Sevilla score and Candida score(positive:Virginia score≥30 points, Sevilla scoring≥ 12 points, Candida score≥ 3 points.Positive means the patients are at high risk of invasive candida infection) Taking the proven and probable two groups as the positive contrast,the non-invasive infection group as a negative control,we calculated and compare the difference of the three fungal scoring systems in sensitivity, specific, positive predictive value, negative predictive value, positive likelihood ratio,negative likelihood ratio and Youden index,and then evaluate the clinical value of them.Results: 1. In 106 patients,5 cases were diagnosed as proven,44 cases as probable, 9 cases as possible and 48 cases as non-invasive infection. The positive results of the three fungal scoring systems in the proven,probable,possible and non-invasive candida infections are:Virginia score:60%,65.9%,55.6%,60.4%; Sevilla score: 60.0%,50.0%,0%,8.3%; Candida score:80%,72.7%,33.3%,29.2%.2.Taking the proven and probable two groups as the positive contrast,the non-invasive infection group as a negative control, the Sensitivity, specificity, positive predictive value, and negative predictive values of the three fungal scoring systems are:Virginia score: 0.86, 0.40, 0.52,0.53; Sevilla score:0.55,0.96,0.93,0.68;Candida score:0.74,0.71,0.72,0.72.3. Combine the three scoring systems: parallel test: Virginia score combined with Sevilla score:sensitivity is 0.84,specificity is 0.4, positive predictive value is 0.59, negative predictive value is 0.70, the Youden index of 0.24. Sevilla score combined CS :sensitivity is 0.80, specificity is 0.71, positive predictive value is 0.77, negative predictive value is 0.77, the Youden index is 0.51. Virginia score combined with CS: sensitivity is 0.80, specificity is 0.35, positive predictive value is 0.55, negative predictive value is 0.63, the Youden index is 0.15. Sequence test: Virginia score combined with Sevilla score: sensitivity is 0.37, specificity is 0.98, positive predictive value is 0.95, negative predictive value is 0.60, the Youden index is 0.35. Sevilla score combined CS:sensitivity is 0.45,specificity is 0.98, positive predictive value is 0.96, negative predictive value is 0.66, the Youden index is 0.43. Virginia score combined with CS: sensitivity degree is 0.59, specificity is 0.79, positive predictive value is 0.80, negative predictive value is 0.66, the Youden index is 0.38.Conclusion:1. Virginia score has higher sensitivity but low specificity, the misdiagnosis rate is high.2. There is well sensitivity and specificity both in sevilla scoring, which could guide the early diagnosis of invasive candida infection separately;3. Compared with the guide, there is highest total diagnosis coincidence rate in Candida score, which is conducive to clinical application;4. Combined Sevilla scoring with CS, the sensitivity and specificity increased than used alone, the comprehensive diagnosis is competent to guide the early diagnosis of invasive candida infection better. |
PDF Full Text Request