Application Value Of G Test Combined With Fungal Score In The Early Diagnosis Of Invasive Candida Infection

Objective:Invasive Candida infection is common in critical patients in intensive care unit,and its prognosis is poor and mortality is high.However,its early definite diagnosis is still controversial.The purpose of this study was to carry out a retrospective study to predict infection in critically ill patients early diagnosis of invasive Candida.by comparing G test combined with sevilla score,G test combined with candida score,G test combined with clinical prediction rule D score.To explore the value of G test combined with fungus score in clinical application to improve diagnostic performance and management efficiency for early clinical diagnosis,exclusion and timely treatment of invasive Candida infection.Methods: 1.Patient selection and data extraction: the data of 180 patients with suspected high-risk factors of invasive candida infection were collected retrospectively from January 2015 to October 2017 in XX Hospital of XX Medical University.Records: basic information of individuals,initial diagnosis of ICU department,basical diseases and complications,length of stay,outcome of illness,culture of bacteria and mycology,etc.According to the guidelines for the diagnosis and treatment of invasive fungal infection in severe patients(2007),the patients were divided into two groups:(1)ICI group(n = 95)and clinical diagnosis group(n = 95),including 37 females and 58 males.The mean age was 67 years old.(2)There were 85 cases of non-invasive candida infection group(including 78 cases of suspected infection group,7 cases of excluding infection group,29 cases of female and 56 cases of male).The average age is 55 years old.2.with reference to the rules developed by the fungal risk scoring system.Four groups of patients were evaluated for G test,G test combined with sevilla score,G test combined with candida score,G test combined with CRP score,(Standard score positive:G test ≥ 60 pg/ ml,sevilla score≥12 points,candida score≥3 points).According to G test combined with any fungal score,which both having the positive score,invasive Candida infection in patients was considered to need treat.The confirmed cases group and the clinical diagnosis group were considered as positive cases,and the suspected infection group and excluded infection group were regarded as negative case control group.The sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio and negative likelihood ratio of three integrated scores(g test and any fungus score)were calculated respectively.The diagnostic value of the three integrated scores was evaluated.Results:1.A total of 180 patients were included in the study.Among them,26 cases(14.4%)were diagnosed as confirmed ICI,69 case(38.3%)as clinical diagnosis ICI,78 cases were diagnosed as suspected diagnosis ICI,and 7 cases were excluded infection.The proportion of positive results of the three integrative scores in the confirmed group was:(G+S score:58%,G+C score:62%,G+D score:54%);in clinical diagnosis group(G+S score:29%、G+C score:25%、G+D score:28%);in suspected diagnosis group(G+S score:5%、G+C score:9%、G+D score:12%);the proportion of the group excluding invasive candida infection in the integration score was zero.2.Taking the proven and probable two groups as the positive contrast,the possible and non-invasive infection two groups as a negative control.The sensitivity,specificity,positive predictive value,negative predictive value and negative predictive value of G Test were 0.47,0.84,0.76,0.59.3.Taking the proven and probable two groups as the positive contrast,the possible and non-invasive infection two groups as a negative control.The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),positive likelihood ratio(LR)and negative likelihood ratio(NLR)of the three integrated scores were as follows:(G+S: 0.40、0.95、0.88、0.57、7.67、0.66、0.24);(G+C: 0.35、0.92、0.83、0.56、4.18、0.71、0.32);(G+D:0.47、0.84、0.76、0.58、3.27、0.73、0.31).Conclusion:1.The specificity of G test is high,but the sensitivity is low,the rate of missing diagnosis is higher.2.The G+S score has good sensitivity and specificity,which superior to the other two scores and can be used to evaluate the early diagnosis and exclusion of invasive Candida infection.3.The sensitivity and specificity of the three scores in the diagnosis of Candida infection are low,and they can be used to identify the patients who are unlikely to benefit from the antifungal infection.