Validation and comparison of clinical prediction rules for invasive candidiasis in intensive care unit patients a matched case-control study 英文参考文献.docVIP

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Validation and comparison of clinical prediction rules for invasive candidiasis in intensive care unit patients a matched case-control study 英文参考文献.doc

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Validation and comparison of clinical prediction rules for invasive candidiasis in intensive care unit patients a matched case-control study 英文参考文献

Hermsenetal.CriticalCare2011,15:R198 /content/15/4/R198 RESEARCH OpenAccess Validationandcomparisonofclinicalprediction rulesforinvasivecandidiasisinintensivecare unitpatients:amatchedcase-controlstudy ElizabethDHermsen1,2,3*,MichelleKZapapas1,MelissaMaiefski1,MarkERupp2,AlisonGFreifeld2and AndreCKalil2 Abstract Introduction:Duetotheincreasingprevalenceandseverityofinvasivecandidiasis,investigatorshavedeveloped clinicalpredictionrulestoidentifypatientswhomaybenefitfromantifungalprophylaxisorearlyempirictherapy. TheaimsofthisstudyweretovalidateandcomparethePaphitouandOstrosky-Zeichnerclinicalpredictionrules inICUpatientsina689-bedacademicmedicalcenter. Methods:Weconductedaretrospectivematchedcase-controlstudyfromMay2003toJune2008toevaluatethe sensitivity,specificity,positivepredictivevalue(PPV)andnegativepredictivevalue(NPV)ofeachrule.Cases includedadultswithICUstaysofatleastfourdaysandinvasivecandidiasismatchedtothreecontrolsbyage, genderandICUadmissiondate.Theclinicalpredictionruleswereappliedtocasesandcontrolsviaretrospective chartreviewtoevaluatethesuccessoftherulesinpredictinginvasivecandidiasis.Paphitou’sruleincluded diabetes,totalparenteralnutrition(TPN)anddialysiswithorwithoutantibiotics.Ostrosky-Zeichner’sruleincluded antibioticsorcentralvenouscatheterplusatleasttwoofthefollowing:surgery,immunosuppression,TPN,dialysis, corticosteroidsandpancreatitis.Conditionallogisticregressionwasperformedtoevaluatetherules.Discriminative powerwasevaluatedbyareaunderthereceiveroperatingcharacteristiccurve(AUCROC). Results:Atotalof352patientswereincluded(88casesand264controls).Theincidenceofinvasivecandidiasis amongadultswithanICUstayofatleastfourdayswas2.3%.Thepredictionrulesperformedsimilarly,exhibitinglow PPVs(0.041to0.054),highNPVs(0.983to0.990)andAUCROCs(0.649to0.705).Anewpredictionrule(Nebraska MedicalCenterrule)wasdevelopedwithPPVs,NPVsandAUCROCsof0.047,0.994and0.770,respectively. Conclusions:BasedonlowPPVsandhighNPVs,therulesaremostusefulforidentifyingpatientswhoar