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

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 A0) had a significantly reduced mortality (P < 0.05) with also shortened duration of ventilator use and ICU stay (P < 0.05) as compared with the 76 patients (Group B0) 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.

Keywords

• intensive care unit
• invasive fungal infection
• multi-disease risk assessment
• efficacy analysis