Abstract:
OBJECTIVE:To develop and internally validate a prediction rule for the presence of candidemia in patients with severe sepsis and septic shock (candidemia rule) that will fill the gap left by previous rules. To compare the accuracy of the available Candida prediction models. DESIGN:Retrospective cohort study. SETTING:Barnes-Jewish Hospital, St. Louis, Missouri. PATIENTS/SUBJECTS:Two thousand five hundred ninety-seven consecutive patients with a positive blood culture and severe sepsis or septic shock. INTERVENTIONS:Logistic regression and a bootstrap resampling procedure were employed for model development and internal validation. MEASUREMENTS AND MAIN RESULTS:Two hundred sixty-six (10.2%) had blood cultures positive for Candida spp. Mortality was significantly higher in patients with candidemia than in patients with bacteremia (47.0% versus 28.4%; P<.001). Administration of total parenteral nutrition, prior antibiotic exposure, transfer from an outside hospital or admission from a nursing home, mechanical ventilation and presence of a central vein catheter were independent predictors of candidemia while the lung as a source for infection was protective. The prediction rule had an area under the receiver operating characteristic curve of 0.798 (95% CI 0.77-0.82). Internal validation using bootstrapping technique with 1000 repetitions produced a similar area under the receiver operating characteristic curve of 0.797 (bias, -0.037; root mean square error 0.039). Our prediction rule outperformed previous rules with a better calibration slope of 0.96 and Brier score of 0.08. CONCLUSIONS:We developed and internally validated a prediction rule for candidemia in hospitalized patients with severe sepsis and septic shock that outperformed previous prediction rules. Our study suggests that locally derived prediction models may be superior by accounting for local case mix and risk factor distribution.
journal_name
J Crit Carejournal_title
Journal of critical careauthors
Guillamet CV,Vazquez R,Micek ST,Ursu O,Kollef Mdoi
10.1016/j.jcrc.2015.03.010subject
Has Abstractpub_date
2015-08-01 00:00:00pages
715-20issue
4eissn
0883-9441issn
1557-8615pii
S0883-9441(15)00108-2journal_volume
30pub_type
杂志文章abstract::Integral to the management of the neurocritically injured patient are the prevention and treatment of hypotension, maintenance of cerebral perfusion pressure, and occasionally blood pressure augmentation. When adequate volume resuscitation fails to meet perfusion needs, vasopressors are often used to restore end-organ...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2016.04.004
更新日期:2016-08-01 00:00:00
abstract:PURPOSE:The aim of this study was to determine the incidence of pressure ulcers (PUs) in ventilated patients in all intensive care units (ICUs) in Granada (Spain) and identify risk factors for their development. MATERIALS AND METHODS:A prospective cohort study in 9 medical-surgical ICUs was conducted. Two hundred nine...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2009.09.002
更新日期:2010-09-01 00:00:00
abstract:PURPOSE:The purpose of this study is to examine the relationship between the occurrence of a difficult intubation and (1) the use of neuromuscular blocking agents (NMB) and (2) the presence of airway injuries. It is a retrospective analysis of data from a trauma registry. MATERIALS AND METHODS:Registry records of pati...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/s0883-9441(98)90022-3
更新日期:1998-03-01 00:00:00
abstract:PURPOSE:During intracranial aneurysm surgery, numerous factors may alter cerebral blood flow and oxygen supply-demand balance. Continuous monitoring of jugular bulb venous oxygen saturation (SvjO2) may help in the anesthetic management of such procedures. MATERIALS AND METHODS:Fiberoptic SvjO2 was continuously monitor...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/s0883-9441(97)90040-x
更新日期:1997-09-01 00:00:00
abstract:PURPOSE:Urinary excretion of chloride corrects metabolic acidosis, but this may be hampered in patients with impaired renal function. We explored the effects of renal function on acid-base characteristics and urinary strong ion excretion using the Stewart approach in critically ill patients with metabolic acidosis. MA...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2011.05.028
更新日期:2012-06-01 00:00:00
abstract:PURPOSE:Nearly all sepsis trials report no statistically significant difference in mortality. The attributable fraction of deaths due to sepsis (AFsepsis) may be an important, yet overlooked consideration. We derived AFsepsis and explored the effect of incorporating AFsepsis into sample size calculations. MATERIALS AN...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2018.01.018
更新日期:2018-06-01 00:00:00
abstract:PURPOSE:Few guidelines exist regarding the selection of a particular type or size of tracheostomy tube. Although nonstandard tubes can be placed over the percutaneous kit dilator, clinicians often place standard tracheostomy tubes and change to nonstandard tubes only after problems arise. This practice risks early trac...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2016.05.025
更新日期:2017-02-01 00:00:00
abstract:OBJECTIVE:Intensive Care Units (ICU) acquired Pneumonia (ICU-AP) is one of the most frequent nosocomial infections in critically ill patients. Our aim was to determine the effects of having an ICU-AP in immunosuppressed patients with acute hypoxemic respiratory failure. DESIGN:Post-hoc analysis of a multinational, pro...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2020.09.027
更新日期:2020-09-29 00:00:00
abstract:PURPOSE:We determined the prevalence of risk factors for the development of acute respiratory distress syndrome (ARDS), outcomes of critical illness, and the impact of highly active antiretroviral therapy in HIV-1-infected patients. We hypothesized that in an urban county hospital, HIV-1-infected patients with ARDS wou...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2014.10.020
更新日期:2015-02-01 00:00:00
abstract:PURPOSE:The mortality rate of severe acute pancreatitis (AP) is 20-30% even after admission to intensive care unit (ICU). Thus we aimed to develop a laboratory-based nomogram to identify AP patients at high risk for mortality. MATERIALS AND METHODS:The primary and validation cohorts were extracted from the Medical Inf...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2018.10.030
更新日期:2019-04-01 00:00:00
abstract:PURPOSE:To assess the risk factors for invasive Candida infection (ICI) caused by fluconazole-resistant (Flu-R) Candida species in intensive care unit (ICU) patients. MATERIALS AND METHODS:Data from China Survey of Candidiasis study were analyzed. Patients with proven ICI were classified into fluconazole-sensitive (Fl...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2015.04.002
更新日期:2015-08-01 00:00:00
abstract:PURPOSE:To determine the incidence of postintubation hypotension (PIH) and associated outcomes in critically ill patients requiring endotracheal intubation. MATERIALS AND METHODS:Medical records were reviewed for 479 consecutive critically ill adult patients who required intubation by an intensive care unit (ICU) serv...
journal_title:Journal of critical care
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jcrc.2015.06.007
更新日期:2015-10-01 00:00:00
abstract:INTRODUCTION:The Competency Based Training in Intensive Care Education (CoBaTrICE) programme developed common standards of ICM training by describing competencies of an intensivist. Entrustable Professional Activities (EPAs) of Intensive Care Medicine (ICM) (EPAsICM) are presented as a new workplace-based assessment to...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2019.09.012
更新日期:2019-12-01 00:00:00
abstract:PURPOSE:Dynamometry is an objective tool for volitional strength evaluation that may overcome the limited sensitivity of the Medical Research Council scale for manual muscle tests, particularly at grades 4 and 5. The primary aims of this study were to investigate the reliability, minimal detectable change, and time to ...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2012.03.001
更新日期:2013-02-01 00:00:00
abstract:PURPOSE:We aimed to evaluate a dosing algorithm for continuous vancomycin administration in intensive care unit patients. MATERIALS AND METHODS:This observational study was conducted in a medical intensive care unit (German university hospital; June 2012-February 2013). Following a loading dose of 20 mg per kg actual ...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2013.12.007
更新日期:2014-06-01 00:00:00
abstract:PURPOSE:This study evaluates the use of transcranial Doppler (TCD) ultrasound in assessing the changes experienced by the cerebral circulation during cardiopulmonary resuscitation (CPR) and compares it with measurements of internal carotid artery (ICA) flow rates (ultrasonic flow-meter measurements) and cerebral blood ...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/0883-9441(94)90013-2
更新日期:1994-09-01 00:00:00
abstract:PURPOSE:Current guidelines for traumatic brain injury (TBI) recommend antiepileptic drugs (AEDs) for 7 days after injury to decrease posttraumatic seizure risk. Phenytoin decreases seizure risk 73% vs placebo during this time. Levetiracetam (LEV) is an alternative; however, no published data validate comparable efficac...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2012.11.020
更新日期:2013-10-01 00:00:00
abstract:PURPOSE:We wanted to identify the importance of the duration of invasive ventilation and of renal replacement therapy for short-term prognosis of surgical patients treated in an intensive care unit (ICU). METHODS:We analyzed adult patients (n = 1462) who had an ICU length of stay of more than 4 days and who were follo...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2011.05.017
更新日期:2012-02-01 00:00:00
abstract:PURPOSE:The purpose of this narrative review is to provide practical and useful guidance for clinicians considering the use of intravenous ketamine for its analgosedative properties in adult, critically ill patients. METHODS:MEDLINE was searched from inception until January 2016. Articles related to the pharmacologica...
journal_title:Journal of critical care
pub_type: 杂志文章,评审
doi:10.1016/j.jcrc.2016.05.016
更新日期:2016-10-01 00:00:00
abstract:BACKGROUND:It is known that acute respiratory distress syndrome and acute lung injury are independent risk factors for developing acute kidney injury (AKI) through complex pathophysiologic mechanisms. Our specific aim is to evaluate the risk factors for AKI postburn injury and whether inhalation thermal injury is an in...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2016.10.008
更新日期:2017-04-01 00:00:00
abstract::While the risk of death after nonthermal trauma and sepsis may be higher for men, sex differences in outcome after burns are inconsistently reported. The Burns Evaluation And Mortality Study examined the outcomes of all patients admitted after thermal injury to the intensive care unit (ICU) at 8 of 9 burn referral cen...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2014.03.021
更新日期:2014-08-01 00:00:00
abstract:BACKGROUND:Extracorporeal membrane oxygenation (ECMO) is an effective support method for acute fulminant myocarditis (AFM) with cardiogenic shock. However, deciding whether to bridge to a left ventricular assist device (LVAD) or to maintain ECMO support until heart recovery is still controversial. MATERIAL AND METHODS...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2020.03.007
更新日期:2020-06-01 00:00:00
abstract:PURPOSE:To evaluate the role of plasma disappearance rate of indocyanine green (PDR-ICG) as an outcome prediction tool in cardiac surgery. PATIENTS AND METHODS:One hundred ninety patients undergoing coronary artery bypass grafting, valve surgery or combined procedures were enrolled. PDR-ICG measurements along with sta...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2013.10.023
更新日期:2014-04-01 00:00:00
abstract:PURPOSE:ECMO use has increased lately. However, differences between adult ECMO and non-ECMO patients admitted to the ICU remain unstudied. In terms of volume-outcome relationship, the impact of ECMO volume on survival has not been validated in a real world cohort. MATERIALS AND METHODS:Retrospective analysis of data f...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2018.09.035
更新日期:2019-02-01 00:00:00
abstract:PURPOSE:Closed endotracheal suctioning (CES) may impact ventilator-associated pneumonia (VAP) risk by reducing environmental contamination. In developing countries where resource limitations constrain the provision of optimal bed space for critically ill patients, CES assumes greater importance. MATERIALS AND METHODS:...
journal_title:Journal of critical care
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jcrc.2010.10.002
更新日期:2011-10-01 00:00:00
abstract:PURPOSE:To explore perspectives of adult critical illness survivors and identify important aspects to care and recovery. MATERIALS AND METHODS:A descriptive, qualitative study of adult survivors of prolonged critical illness, six-months after Intensive Care Unit (ICU) discharge, using semi-structured interviews and th...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2020.01.028
更新日期:2020-06-01 00:00:00
abstract:PURPOSE:Hypoxia is one of the leading causes of anesthesia-related injury. In response to the limitations of conventional preoxygenation, Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) has been used as a method of providing both preoxygenation and apneic oxygenation during intubation. MATERIALS...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2016.06.011
更新日期:2016-12-01 00:00:00
abstract:PURPOSE:The purpose of the study is to describe the role of human metapneumovirus (hMPV) infection in critical illness and acute respiratory distress syndrome (ARDS). MATERIALS AND METHODS:We collected clinical and demographic information from a retrospective chart review, comparing patients with and without an intens...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2015.09.035
更新日期:2016-02-01 00:00:00
abstract:PURPOSE:The purpose of this study is to examine the impact of hypernatremia acquired after intensive care unit (ICU) admission on mortality and length of stay (LOS). MATERIALS AND METHODS:Data for this observational study were collected from patients admitted between January 1, 2008, and September 30, 2010 to 344 ICUs...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2012.11.013
更新日期:2013-08-01 00:00:00
abstract:PURPOSE:Alcohol-use disorders (AUDs) have been associated with increased sepsis-related mortality. As patients with AUDs are often thiamine deficient, we investigated practice patterns relating to thiamine administration in patients with AUDs presenting with septic shock and explored the association between receipt of ...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2017.08.022
更新日期:2018-02-01 00:00:00