Related Research On Critically Ill Patients With Non-Neutropenia Suffered From Invasive Fungal Infection

Part 1 Research on risk factors of invasive fungal infection and prognosis of fungal infection in critically ill patients with non-neutropeniaObjective:We are aim to explore the independent risk factor（s）of invasive fungal infection in critically ill patients with non-neutropenia and to explore the independent factors affecting the ICU hospitalized mortality rate of critically ill patients with invasive fungal infections,thus we can compare the difference between the predicted mortality index and the ICU commonly used prediction scores in the accuracy of predicting death.Methods:From October 1st,2017 to October 1st,2019,We collected data of 82 critical ill patients with non-neutropenia admitted to our hospital’s intensive care units.Every patient was first diagnosed with invasive fungal infection in our hospital.The trial consisted two groups,one of which are 82patients diagnosed with invasive fungal infections and the other group 80patients with non-invasive fungal infections who were hospitalized during the same period.Through non-parametric test or Chi-square test,we analyzed significant factors of invasive fungal infection in critically ill patients.Then we find independent risk factors of invasive fungal infection in critically ill patients by multi-factor logistic regression analysis.Furthermore,we also recorded the ICU hospitalized infection outcome of 82 critically ill patients with invasive fungal infection.According to different outcomes,they were divided into 49cases in the survival group and 33 cases in the death group.We identified independent factors that affect the ICU hospitalized death of critically ill patients with IFI,calculated the predictive death index,and compared the difference between the predicted mortality index and the ICU commonly used prediction scores in the accuracy of predicting death.Results:（1）The occurrence of invasive fungal infection in critically ill patients are significantly associated with three factors:time to stay in ICU,suffering from severe pneumonia and developing into multiple organ failure.（2）The independent risk factors affecting the ICU hospitalized mortality in critically ill patients with IFI in intensive care unit are the patients Therapeutic Intervention Scoring System（TISS）scores（≥21 scores）and CD₈⁺T lymphocyte counts at the time of fungal infection diagnosed（cut-off index=112ug/L）,combined with patients in condition of old age（≥70 years old）.The predictive mortality index calculated by above three factors has a higher accuracy rate in predicting death than commonly used ICU predictive scores such as APACHEⅡscore,SOFA score and TISS score.Conclusion:（1）Time staying in the ICU,suffering from severe pneumonia,and developing into multiple organ failure are independent risk factors for invasive fungal infections in critically ill patients with non-neutropenia.（2）The predictive accuracy of mortality predictive index calculated by independent factors of the the ICU hospitalized mortality rate of critically ill patients with invasive fungal infection is higher than ICU commonly used predictive scores to predict the death accuracy of patients.Part 2 Non-randomized controlled trial of empirical therapy and preemptive therapy for critically ill non-neutropenia patients with invasive fungal infectionObjective: To study the differences caused between early empirical therapy and preemptive therapy,two main invasive fungal infections therapy methods,on the critically ill patients with non-neutropenia in terms of 28 days mortality after infected,length of stay in ICU and length of hospitalization,cost of fungal drugs and hospitalization,serum inflammatory factors and severity of illness scores,et cetera.Methods: From October 1,2017 to October 1,2019,We incorporated 122 critically ill patients with non-neutropenia firstly diagnosed with invasive fungal infection in our ICU of hospital.Among them,61 critically ill patients,not found to have fungal infective microorganisms or infective imaging evidence,were treated with early empirical therapy and they were classified as empirical therapy group.The remaining 61 critically ill patients,who were treated with fungal medication after definitive fungal infection of microorganisms or imaging evidence,were treated with preemptive therapy and they were classified as preemptive therapy group.All included patients with IFI have already excluded previously diagnosed or primary IFI.（1）On the account of the baseline data（age）of the two groups of patients could not be matched and the evaluation of effects of methods required two group patients have the similar severity of illness,the propensity score method was used to exclude patients who could not match the baseline data,and finally100 patients were included.There were 50 patients in the empirical therapy group and the preemptive therapy group,respectively.We aimed to compare the differences in 28 days mortality,time stay in ICU and in hospital,anti-fungal drug costs and medical costs during hospitalization between two group critically ill patients.（2）We aimed to compare the differences in the levels of inflammatory factors and severity scores during hospitalization between 50 critically ill patients in empirical therapy group and their counterparts in the preemptive therapy group.Results:（1）The incidence of major adverse reactions was higher in the preemptive therapy group patients than in the empirical therapy group counterparts,but only occurrence of sepsis was significant in preemptive therapy group patients and other complications not found have significant difference.Empirical therapy and preemptive therapy have no statistically significant difference in 28-day mortality of critically ill patients with IFI.The days of patients diagnosed fungal infections in empirical group stayed in ICU and the time have stayed in ICU were significantly longer than their counterparts in the preemptive therapy group,the difference was statistically significant（P<0.05）.It can be presumably thought that preemptive treatment may have certain advantages over empirical treatment in the outcome related variables.（2）There was no statistically significant difference between the two therapy group patients in the severity scores in APACHE Ⅱ scores,SOFA scores and inflammatory cytokines indexes in procalcitonin,blood lactic acid,C-reactive protein,and white blood cell counts during the hospitalization of critically ill patients with invasive fungal infection.Conclusion: Preemptive therapy may have certain advantages over empirical therapy in the outcome variables of invasive fungal infections in critically ill patients with non-neutropenia.Part 3 Survival analysis of critically ill patients with invasive fungal infectionObjective: Follow up the different survival outcomes of critically ill patients with non-neutropenia in follow-up period,we analyze the risk factors affecting the mortality of critically ill patients with fungal infections and conduct a risk assessment of death outcome.Methods:Follow up the discharged patients to the end of our period-October 1,2019,we get the outcome of discharged patients through regular telephone calls.We used a multi-factor COX regression analysis method to analyze the risk factors that affected patients 28-day death based the death of individual is final case.Then,we calculate a death predictive model and use ROC curve analysis to determine the cut-off index of model that distinguish high-risk death individuals from critically ill patients with fungal infection;Thus,Kaplan-Meier survival analysis was used to analyze the differences in survival outcome between the high-risk death group and low-risk death group.Results:The death in critically patients with IFI mostly occur within 4weeks after infected,after that the survival rate of patients tends to stabilize.After performing dimensionality reduction by the principal component analysis method,we set the probability index boundary value of the predicted long-term survival outcome of patients with invasive fungal infection to 2.98.Use this cut-off index to distinguish patients from the high-risk of death and a low-risk of death.The difference in mortality risk between the two groups is significant and statistically significant.Meanwhile,the maximum principal factor value may indicate the most important risk factor that may affect the patient’s death,which accurately improved the rapid recovery of critically ill patients with high-risk death radio.Conclusion: The principal component model constructed by exploring the relationship in survival rate of critically ill patients with IFI can hint the most risk factors leading to the death.Thus,we can distinguish those patients with fungal infection high risk of death and accurately improved the rapid recovery of critically ill patients through tackle the most important factors affecting patient’s death.