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Article(id=1199335051256234000, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1199335049175859209, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.1385.2023.0626, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1655740800000, receivedDateStr=2022-06-21, revisedDate=null, revisedDateStr=null, acceptedDate=1661616000000, acceptedDateStr=2022-08-28, onlineDate=1763873358787, onlineDateStr=2025-11-23, pubDate=1711555200000, pubDateStr=2024-03-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1763873358787, onlineIssueDateStr=2025-11-23, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1763873358787, creator=13701087609, updateTime=1763873358787, updator=13701087609, issue=Issue{id=1199335049175859209, tenantId=1146029695717560320, journalId=1189873630562394117, year='2024', volume='49', issue='3', pageStart='245', pageEnd='366', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1763873358291, creator=13701087609, updateTime=1763874044185, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1199337926086721596, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1199335049175859209, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1199337926086721597, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1199335049175859209, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=280, endPage=287, ext={EN=ArticleExt(id=1199335051642109971, articleId=1199335051256234000, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Construction and validation of a scoring model for pathogen characteristics and short-term prognosis risk prediction of candidemia, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To analyze the pathogenic characteristics and drug sensitivity of candidaemia, and construct a short-term mortality risk prediction scoring model. Methods The clinical data of patients with candidaemia admitted to the 909 Hospital of Joint Logistics Support Force from January 2011 to December 2020 were retrospectively analyzed, and the composition of pathogen composition, drug sensitivity test results and incidence of hospitalized patients were analyzed. 324 cases of candidaemia were randomly divided into modeling group (190 cases) and validation group (134 cases), and the risk factors were screened by binary logistic regression. According to the odds ratio (OR) score, the 30 day mortality risk prediction scoring model was constructed, and the predictive performance of the model was verified both in modeling and validation groups. Results 356 strains of Candida including 126 strains of C. albicans (35.39%), 79 strains of C. tropicalis (22.19%), 74 strains of C. parapsilosis (20.79%), 48 strains of C. glabrata (13.48%), 14 strains of C. guilliermondii (3.93%), 8 strains of C. krusei (2.25%), and 7 strains of other Candida (1.97%) were detected in 336 patients with candidemia. The incidence of candidaemia among hospitalized patients increased from 0.20 ‰ in 2011 to 0.48 ‰ in 2020. The resistance rate of candida to amphotericin B was significantly lower than that of fluconazole, voriconazole and itraconazole (P<0.05). Among the 324 cases included in the model, 95 patients died in 30 days after diagnosis, and the mortality rate was 29.32%. The proportion of males, fever, and parenteral nutrition in modeling group was significantly higher than that in validation group (P<0.05), while the proportion of chronic lung disease and surgical history within one month were lower than those in validation group (P<0.05). Logistic regression analysis showed that chronic renal failure, mechanical ventilation, severe neutropenia, failure to receive anti-fungal treatment within 72 hours, and APACHE Ⅱ ≥20 were risk factors for short-term death of candidaemia, the OR values were 3.179, 1.970, 2.979, 2.080, and 2.399, and the risk scores were 6, 4, 6, 4, and 5, respectively. The area under the curve (AUC) of the risk scoring model for modeling group was 0.792 (95%CI 0.721-0.862), and the result of Hosmer-Lemeshow (H-L) test was P=0.305; The AUC of validation group was 0.796 (95%CI 0.735-0.898), and the H-L test result was P=0.329. A risk score ≤8 indicated a low risk group for short-term mortality, a score of 9-15 indicated a medium risk group, and a score ≥16 indicated a high risk group. Conclusions The incidence of candidemia in hospitalized patients is increasing and the mortality is high. The risk prediction score model can effectively predict the short-term prognosis and facilitate the early identification of the prognosis.

, correspAuthors=Sheng-Qiang Liang, authorNote=null, correspAuthorsNote=
E-mail:
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目的 分析念珠菌菌血症的病原菌特征，构建并验证其短期死亡风险预测评分模型。方法 回顾性分析2011年1月1日-2020年12月31日联勤保障部队第909医院收治的念珠菌菌血症患者的临床资料，分析病原菌构成、药敏试验结果和住院患者发生率。选取念珠菌菌血症324例随机纳入建模组(190例)、验证组(134例)，采用二元logistic回归筛选危险因素，依据比值比(OR)赋分，构建30 d死亡风险预测评分模型。运用预测评分模型对建模组、验证组进行评分，验证预测模型的预测效能。结果 336例念珠菌菌血症患者共检出念珠菌356株，其中白色念珠菌126株(35.39%)，热带念珠菌79株(22.19%)，近平滑念珠菌74株(20.79%)，光滑念珠菌48株(13.48%)，季也蒙念珠菌14株(3.93%)，克柔念珠菌8株(2.25%)，其他念珠菌7株(1.97%)；住院患者念珠菌菌血症发生率从2011年的0.20‰上升到2020年的0.48‰。念珠菌对两性霉素B耐药率明显低于氟康唑、伏立康唑、伊曲康唑(P<0.05)。纳入模型分析的324例中，确诊后30 d死亡95例，病死率29.32%；建模组男性、发热、肠外营养占比明显高于验证组(P<0.05)，慢性肺病、1个月内手术史占比均低于验证组(P<0.05)。Logistic回归分析结果显示，慢性肾衰竭、机械通气、重度中性粒细胞降低、72 h内未接受抗真菌治疗、急性生理和慢性健康状况Ⅱ评分(APACHE Ⅱ)≥20分为念珠菌菌血症短期死亡的危险因素(P<0.05)，OR值分别为3.179、1.970、2.979、2.080、2.399，风险赋分分别为6、4、6、4、5。风险评分模型对建模组ROC曲线下面积(AUC)为0.792(95%CI 0.721~0.862)，Hosmer-Lemeshow(H-L)检验结果为P=0.305；验证组AUC为0.796(95%CI 0.735~0.898)，H-L检验结果为P=0.329。风险评分≤8分为短期死亡低风险组，评分9~15分为中风险组，评分≥16分为高风险组。结论 住院患者念珠菌菌血症发生率呈上升趋势，病死率较高；构建的念珠菌菌血症短期死亡风险预测评分模型预测效能较好。

, correspAuthors=梁声强, authorNote=null, correspAuthorsNote=
梁声强，E-mail：
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马建新，主管技师，主要从事临床医学检验方面的研究

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马建新，主管技师，主要从事临床医学检验方面的研究

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马建新，主管技师，主要从事临床医学检验方面的研究

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J Fungi (Basel), 2021, 7(6): 442., articleTitle=Risk factors for mortality in Colombian patients with candidemia, refAbstract=null), Reference(id=1199335065177129475, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, doi=null, pmid=null, pmcid=null, year=2020, volume=45, issue=10, pageStart=1484, pageEnd=1486, url=null, language=null, rfNumber=[24], rfOrder=23, authorNames=赵越, 袁凯旋, 叶龙, journalName=重庆医科大学学报, refType=null, unstructuredReference=赵越, 袁凯旋, 叶龙, 等. 165例老年念珠菌血症患者的临床特征分析及预后评价[J]. 重庆医科大学学报, 2020, 45(10): 1484-1486., articleTitle=165例老年念珠菌血症患者的临床特征分析及预后评价, refAbstract=null), Reference(id=1199335065281987078, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, doi=null, pmid=null, pmcid=null, year=2019, volume=97, issue=4, pageStart=579, pageEnd=587, url=null, language=null, rfNumber=[25], rfOrder=24, authorNames=Trifi A, Abdellatif S, Daly F, journalName=La Tunisie Med, refType=null, unstructuredReference=Trifi A, Abdellatif S, Daly F, et al. Empiric antifungal and outcome in ICU patients[J]. La Tunisie Med, 2019, 97(4): 579-587., articleTitle=Empiric antifungal and outcome in ICU patients, refAbstract=null), Reference(id=1199335065336513032, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, doi=null, pmid=null, pmcid=null, year=2010, volume=54, issue=1, pageStart=184, pageEnd=190, url=null, language=null, rfNumber=[26], rfOrder=25, authorNames=Taur Y, Cohen N, Dubnow S, journalName=Antimicrob Agents Chemother, refType=null, unstructuredReference=Taur Y, Cohen N, Dubnow S, et al. Effect of antifungal therapy timing on mortality in cancer patients with candidemia[J]. Antimicrob Agents Chemother, 2010, 54(1): 184-190., articleTitle=Effect of antifungal therapy timing on mortality in cancer patients with candidemia, refAbstract=null), Reference(id=1199335065412010508, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, doi=null, pmid=null, pmcid=null, year=2016, volume=34, issue=null, pageStart=39, pageEnd=44, url=null, language=null, rfNumber=[27], rfOrder=26, authorNames=Tedeschi S, Tumietto F, Giannella M, journalName=Eur J Intern Med, refType=null, unstructuredReference=Tedeschi S, Tumietto F, Giannella M, et al. Epidemiology and outcome of candidemia in internal medicine wards: a regional study in Italy[J]. Eur J Intern Med, 2016, 34: 39-44., articleTitle=Epidemiology and outcome of candidemia in internal medicine wards: a regional study in Italy, refAbstract=null)], funds=[Fund(id=1199335060915716487, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, awardId=JK20191A040324, language=EN, fundingSource=Military Equipment Scientific Research Project of PLA(JK20191A040324), fundOrder=null, country=null), Fund(id=1199335060982825355, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, awardId=JK20191A040324, language=CN, fundingSource=军队军事科学装备科研项目(JK20191A040324), fundOrder=null, country=null), Fund(id=1199335061079294356, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, awardId=ZZ2020KD04, language=EN, fundingSource=Science and Technology Military Support Project of Zhangzhou(ZZ2020KD04), fundOrder=null, country=null), Fund(id=1199335061188346265, 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figs=[ArticleFig(id=1199335057639964934, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, language=EN, label=Fig.1, caption=Prevalence of candidaemia and candida detection in the 909 Hospital of Joint Logistics Support Force in 2011-2020, figureFileSmall=ey3kNTQl+ZZWmdNLt/h+xg==, figureFileBig=25Uemm4v0XIh1b/7RY61CQ==, tableContent=null), ArticleFig(id=1199335057719656713, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, language=CN, label=图1, caption=2011-2020年联勤保障部队第909医院念珠菌菌血症发生率和念珠菌检出情况, figureFileSmall=ey3kNTQl+ZZWmdNLt/h+xg==, figureFileBig=25Uemm4v0XIh1b/7RY61CQ==, tableContent=null), ArticleFig(id=1199335057983897882, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, language=EN, label=Fig.2, caption=The case fatality rates of candidaemia patients with different scores of candidemia in model group and validation group, figureFileSmall=PztPQ3UumuG6Itph0fpqZw==, figureFileBig=ajAb1NycOqULmGjhPyOtlw==, tableContent=null), ArticleFig(id=1199335058101338402, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, language=CN, label=图2, caption=建模组、验证组不同分值念珠菌菌血症患者的病死率分布, figureFileSmall=PztPQ3UumuG6Itph0fpqZw==, figureFileBig=ajAb1NycOqULmGjhPyOtlw==, tableContent=null), ArticleFig(id=1199335058218778921, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, language=EN, label=Fig.3, caption=ROC curve of patients in model group (A) and validation group (B) based on the 30-day mortality risk prediction score model of candidaemia, figureFileSmall=VHB0jc4J/598LQfGlaec4A==, figureFileBig=rIxD0hJfx2plxL3JBMhLGQ==, tableContent=null), ArticleFig(id=1199335058432688437, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, language=CN, label=图3, caption=念珠菌菌血症30 d死亡风险预测评分模型用于建模组(A)和验证组(B)的ROC曲线, figureFileSmall=VHB0jc4J/598LQfGlaec4A==, figureFileBig=rIxD0hJfx2plxL3JBMhLGQ==, tableContent=null), ArticleFig(id=1199335058562711870, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, language=EN, label=Fig.4, caption=Risk stratification and case fatality rates of patients in model group and validation group based on the 30 day mortality risk prediction score model of candidaemia, figureFileSmall=flk/+N5h6O7Uty63hESSCA==, figureFileBig=pb5JupMSGOOIF35gMiS+lQ==, tableContent=null), ArticleFig(id=1199335058688540995, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, language=CN, label=图4, caption=基于念珠菌菌血症风险预测评分模型的建模组、验证组短期病死率风险分层, figureFileSmall=flk/+N5h6O7Uty63hESSCA==, figureFileBig=pb5JupMSGOOIF35gMiS+lQ==, tableContent=null), ArticleFig(id=1199335058856313162, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, language=EN, label=Tab.1, caption=

The results of drug sensitivity test on different Candida species

, figureFileSmall=null, figureFileBig=null, tableContent=
真菌类别抗真菌药物MIC(μg/ml)药敏试验结果[株(%)]
范围MIC50MIC90敏感SDD耐药
白色念珠菌(n=126)氟康唑0.5~16.0≤1.04.0119(94.44)2(1.59)5(3.97)
伏立康唑0.03~4.000.061.0114(90.48)012(9.52)
伊曲康唑0.062~1.000≤0.1250.125NANANA
两性霉素B0.25~1.00≤0.50.5126(100.00)00
近平滑念珠菌(n=74)氟康唑0.5~8.0≤1.0≤4.068(91.89)3(4.05)3(4.05)
伏立康唑0.03~0.25≤0.060.12564(86.49)4(5.41)6(8.11)
伊曲康唑0.06~0.25≤0.1250.12565(87.84)09(12.16)
两性霉素B0.25~1.00≤0.50.574(100.00)00
热带念珠菌(n=79)氟康唑1~3211650(63.29)3(3.80)26(32.91)
伏立康唑0.06~4.000.060.571(89.87)4(5.06)4(5.06)
伊曲康唑0.125~8.0000.1251.041(51.90)038(48.10)
两性霉素B0.25~0.50≤0.50.579(100.00)00
光滑念珠菌(n=48)氟康唑1~16416048(100.00)0
伏立康唑0.06~0.500.1254.0NANANA
伊曲康唑0.125~1.0000.251.0NANANA
两性霉素B0.25~1.00≤0.50.546(95.83)02(4.17)
克柔念珠菌(n=8)氟康唑64NANA008(100.00)
伏立康唑0.5NANA6(75.00)02(25.00)
伊曲康唑1NANANANANA
两性霉素B1NANA8(100.00)00
季也蒙念珠菌(n=14)氟康唑1~1621612(85.71)02(14.29)
伏立康唑0.25~1.000.05≤1.06(42.86)4(28.57)4(28.57)
伊曲康唑0.25~1.000.1251.04(28.57)4(28.57)6(42.86)
两性霉素B0.5~1.0≤0.50.514(100.00)00
其他(n=7)氟康唑1~16≤216NANANA
伏立康唑0.06~2.00≤0.062.0NANANA
伊曲康唑0.125~1.0000.1251.0NANANA
两性霉素B≤0.5≤0.50.5NANANA
), ArticleFig(id=1199335058977947986, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, language=CN, label=表1, caption=

不同念珠菌药敏试验结果

, figureFileSmall=null, figureFileBig=null, tableContent=
真菌类别抗真菌药物MIC(μg/ml)药敏试验结果[株(%)]
范围MIC50MIC90敏感SDD耐药
白色念珠菌(n=126)氟康唑0.5~16.0≤1.04.0119(94.44)2(1.59)5(3.97)
伏立康唑0.03~4.000.061.0114(90.48)012(9.52)
伊曲康唑0.062~1.000≤0.1250.125NANANA
两性霉素B0.25~1.00≤0.50.5126(100.00)00
近平滑念珠菌(n=74)氟康唑0.5~8.0≤1.0≤4.068(91.89)3(4.05)3(4.05)
伏立康唑0.03~0.25≤0.060.12564(86.49)4(5.41)6(8.11)
伊曲康唑0.06~0.25≤0.1250.12565(87.84)09(12.16)
两性霉素B0.25~1.00≤0.50.574(100.00)00
热带念珠菌(n=79)氟康唑1~3211650(63.29)3(3.80)26(32.91)
伏立康唑0.06~4.000.060.571(89.87)4(5.06)4(5.06)
伊曲康唑0.125~8.0000.1251.041(51.90)038(48.10)
两性霉素B0.25~0.50≤0.50.579(100.00)00
光滑念珠菌(n=48)氟康唑1~16416048(100.00)0
伏立康唑0.06~0.500.1254.0NANANA
伊曲康唑0.125~1.0000.251.0NANANA
两性霉素B0.25~1.00≤0.50.546(95.83)02(4.17)
克柔念珠菌(n=8)氟康唑64NANA008(100.00)
伏立康唑0.5NANA6(75.00)02(25.00)
伊曲康唑1NANANANANA
两性霉素B1NANA8(100.00)00
季也蒙念珠菌(n=14)氟康唑1~1621612(85.71)02(14.29)
伏立康唑0.25~1.000.05≤1.06(42.86)4(28.57)4(28.57)
伊曲康唑0.25~1.000.1251.04(28.57)4(28.57)6(42.86)
两性霉素B0.5~1.0≤0.50.514(100.00)00
其他(n=7)氟康唑1~16≤216NANANA
伏立康唑0.06~2.00≤0.062.0NANANA
伊曲康唑0.125~1.0000.1251.0NANANA
两性霉素B≤0.5≤0.50.5NANANA
), ArticleFig(id=1199335059158303065, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, language=EN, label=Tab.2, caption=

Comparison of clinical data of candidaemia patients in two groups [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量

建模组
(n=190)

验证组
(n=134)

χ2P
年龄>60岁67(35.3)41(44.1)0.7700.380
性别(男)139(73.2)84(62.7)4.0160.045

基础疾病
实体瘤

40(21.1)

32(23.9)

0.364

0.547

恶性血液病44(23.2)35(26.1)0.3740.541
糖尿病35(18.4)30(22.4)0.4050.524
心血管疾病16(8.4)17(12.7)1.5630.211
慢性肺病19(10.0)25(18.7)5.0180.025
慢性肾衰竭20(10.5)13(9.7)0.0580.809
1个月内手术史64(33.7)63(47.0)5.8590.015
2个月内糖皮质激素用药史20(10.5)19(14.2)0.9900.320
6个月内抗真菌药物使用史37(19.5)32(23.9)0.9110.340
2个月内抗生素使用史171(90.0)122(91.0)0.0990.753
发热143(75.3)86(64.2)4.6580.031
肠外营养90(47.4)48(35.8)4.2850.038
机械通气72(37.7)61(45.5)1.8890.169
中央静脉置管116(61.1)85(63.4)0.1890.664
介入操作89(46.8)66(49.3)0.1830.669
重度中性粒细胞降低23(12.1)19(14.2)0.3000.584
72 h内未接受抗真菌治疗52(27.4)46(34.3)1.8040.179
APACHE Ⅱ≥20分117(61.6)86(64.2)0.2270.634
SOFA评分≥4分107(56.3)81(60.4)0.5510.458
死亡56(29.5)39(29.1)0.0050.943
), ArticleFig(id=1199335060328513889, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, language=CN, label=表2, caption=

两组念珠菌菌血症患者临床资料比较[例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量

建模组
(n=190)

验证组
(n=134)

χ2P
年龄>60岁67(35.3)41(44.1)0.7700.380
性别(男)139(73.2)84(62.7)4.0160.045

基础疾病
实体瘤

40(21.1)

32(23.9)

0.364

0.547

恶性血液病44(23.2)35(26.1)0.3740.541
糖尿病35(18.4)30(22.4)0.4050.524
心血管疾病16(8.4)17(12.7)1.5630.211
慢性肺病19(10.0)25(18.7)5.0180.025
慢性肾衰竭20(10.5)13(9.7)0.0580.809
1个月内手术史64(33.7)63(47.0)5.8590.015
2个月内糖皮质激素用药史20(10.5)19(14.2)0.9900.320
6个月内抗真菌药物使用史37(19.5)32(23.9)0.9110.340
2个月内抗生素使用史171(90.0)122(91.0)0.0990.753
发热143(75.3)86(64.2)4.6580.031
肠外营养90(47.4)48(35.8)4.2850.038
机械通气72(37.7)61(45.5)1.8890.169
中央静脉置管116(61.1)85(63.4)0.1890.664
介入操作89(46.8)66(49.3)0.1830.669
重度中性粒细胞降低23(12.1)19(14.2)0.3000.584
72 h内未接受抗真菌治疗52(27.4)46(34.3)1.8040.179
APACHE Ⅱ≥20分117(61.6)86(64.2)0.2270.634
SOFA评分≥4分107(56.3)81(60.4)0.5510.458
死亡56(29.5)39(29.1)0.0050.943
), ArticleFig(id=1199335060454343017, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, language=EN, label=Tab.3, caption=

Univariate analysis on death of 190 candidaemia patients within 30 d [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量

30 d内死亡组
(n=56)

30 d内存活组
(n=134)

χ2P
年龄>60岁25(44.6)42(31.3)3.0600.080
性别(男)39(69.6)100(74.6)0.5000.480
基础疾病
实体瘤12(21.4)28(20.9)0.0070.935
恶性血液病14(25.0)30(22.4)0.1510.697
糖尿病11(19.6)24(17.9)0.0790.779
心血管疾病6(10.7)10(7.5)0.5420.462
慢性肺病7(12.5)12(9.0)0.5510.458
慢性肾衰竭12(21.4)8(6.0)10.0210.002
1个月内手术史20(35.7)44(32.8)0.1460.702
2个月内糖皮质激素用药史7(12.5)13(9.7)0.3280.567
6个月内抗真菌药物使用史13(23.2)24(17.9)0.7080.400
2个月内抗生素使用史49(87.5)122(91.0)0.5510.458
发热45(80.4)98(73.1)1.1070.293
肠外营养28(50.0)62(46.3)0.2210.639
机械通气29(51.8)43(32.1)6.5100.011
中央静脉置管37(66.1)79(59.0)0.8410.359
介入操作33(58.9)56(41.8)4.6580.031
重度中性粒细胞降低12(21.4)11(8.2)6.4870.011
72 h内未接受抗真菌治疗21(37.5)31(23.1)4.1000.043
APACHE Ⅱ≥20分41(73.2)76(56.7)4.5440.033
SOFA评分≥4分35(62.5)72(53.7)1.2340.267
), ArticleFig(id=1199335060555006318, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, language=CN, label=表3, caption=

念珠菌菌血症190例30 d内死亡单因素分析[例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量

30 d内死亡组
(n=56)

30 d内存活组
(n=134)

χ2P
年龄>60岁25(44.6)42(31.3)3.0600.080
性别(男)39(69.6)100(74.6)0.5000.480
基础疾病
实体瘤12(21.4)28(20.9)0.0070.935
恶性血液病14(25.0)30(22.4)0.1510.697
糖尿病11(19.6)24(17.9)0.0790.779
心血管疾病6(10.7)10(7.5)0.5420.462
慢性肺病7(12.5)12(9.0)0.5510.458
慢性肾衰竭12(21.4)8(6.0)10.0210.002
1个月内手术史20(35.7)44(32.8)0.1460.702
2个月内糖皮质激素用药史7(12.5)13(9.7)0.3280.567
6个月内抗真菌药物使用史13(23.2)24(17.9)0.7080.400
2个月内抗生素使用史49(87.5)122(91.0)0.5510.458
发热45(80.4)98(73.1)1.1070.293
肠外营养28(50.0)62(46.3)0.2210.639
机械通气29(51.8)43(32.1)6.5100.011
中央静脉置管37(66.1)79(59.0)0.8410.359
介入操作33(58.9)56(41.8)4.6580.031
重度中性粒细胞降低12(21.4)11(8.2)6.4870.011
72 h内未接受抗真菌治疗21(37.5)31(23.1)4.1000.043
APACHE Ⅱ≥20分41(73.2)76(56.7)4.5440.033
SOFA评分≥4分35(62.5)72(53.7)1.2340.267
), ArticleFig(id=1199335060680835445, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, language=EN, label=Tab.4, caption=

The results of logistic regression analysis on 30-day mortality risk of candidaemia patients and assignment in the prediction model

, figureFileSmall=null, figureFileBig=null, tableContent=
变量βWald χ2POR95%CI赋值
慢性肾衰竭1.3136.1050.0133.1791.312~10.5406
机械通气0.6784.3490.0371.9701.042~3.7274
重度中性粒细胞降低1.0915.6620.0172.9791.212~7.3196
72 h内未接受抗真菌治疗0.7324.5020.0342.0801.057~4.0914

APACHE Ⅱ

≥20分

0.8755.2240.0222.3991.133~5.0825
), ArticleFig(id=1199335060798275967, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335051256234000, language=CN, label=表4, caption=

念珠菌菌血症患者30 d内死亡的危险因素logistic回归分析结果及在预测模型中的赋值

, figureFileSmall=null, figureFileBig=null, tableContent=
变量βWald χ2POR95%CI赋值
慢性肾衰竭1.3136.1050.0133.1791.312~10.5406
机械通气0.6784.3490.0371.9701.042~3.7274
重度中性粒细胞降低1.0915.6620.0172.9791.212~7.3196
72 h内未接受抗真菌治疗0.7324.5020.0342.0801.057~4.0914

APACHE Ⅱ

≥20分

0.8755.2240.0222.3991.133~5.0825
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念珠菌菌血症病原菌特点及短期预后风险预测评分模型的构建与验证
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马建新 1 , 林小强 1 , 蔡明池 1 , 许玉珍 1 , 彭俊 2 , 梁声强 1, *
解放军医学杂志 | 临床研究 2024,49(3): 280-287
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解放军医学杂志 | 临床研究 2024, 49(3): 280-287
念珠菌菌血症病原菌特点及短期预后风险预测评分模型的构建与验证
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马建新1, 林小强1, 蔡明池1, 许玉珍1, 彭俊2, 梁声强1, *
作者信息
  • 1解放军联勤保障部队第909医院(厦门大学附属东南医院)检验科，福建漳州 363000
  • 2中南大学湘雅医学院附属株洲医院检验科，湖南株洲 413007

    • 马建新，主管技师，主要从事临床医学检验方面的研究

通讯作者:

梁声强，E-mail：
Construction and validation of a scoring model for pathogen characteristics and short-term prognosis risk prediction of candidemia
Jian-Xin Ma1, Xiao-Qiang Lin1, Ming-Chi Cai1, Yu-Zhen Xu1, Jun Peng2, Sheng-Qiang Liang1, *
Affiliations
  • 1Department of Laboratory, the 909th Hospital of Joint Logistic Support Force of PLA, Dongnan Hospital of Xiamen University, Zhangzhou, Fujian 363000, China
  • 2Department of Laboratory, Zhuzhou Hospital Affiliated to Xiangya Medical College of Central South University, Zhuzhou, Hunan 413007, China
出版时间: 2024-03-28 doi: 10.11855/j.issn.0577-7402.1385.2023.0626
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摘要
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目的 分析念珠菌菌血症的病原菌特征，构建并验证其短期死亡风险预测评分模型。方法 回顾性分析2011年1月1日-2020年12月31日联勤保障部队第909医院收治的念珠菌菌血症患者的临床资料，分析病原菌构成、药敏试验结果和住院患者发生率。选取念珠菌菌血症324例随机纳入建模组(190例)、验证组(134例)，采用二元logistic回归筛选危险因素，依据比值比(OR)赋分，构建30 d死亡风险预测评分模型。运用预测评分模型对建模组、验证组进行评分，验证预测模型的预测效能。结果 336例念珠菌菌血症患者共检出念珠菌356株，其中白色念珠菌126株(35.39%)，热带念珠菌79株(22.19%)，近平滑念珠菌74株(20.79%)，光滑念珠菌48株(13.48%)，季也蒙念珠菌14株(3.93%)，克柔念珠菌8株(2.25%)，其他念珠菌7株(1.97%)；住院患者念珠菌菌血症发生率从2011年的0.20‰上升到2020年的0.48‰。念珠菌对两性霉素B耐药率明显低于氟康唑、伏立康唑、伊曲康唑(P<0.05)。纳入模型分析的324例中，确诊后30 d死亡95例，病死率29.32%；建模组男性、发热、肠外营养占比明显高于验证组(P<0.05)，慢性肺病、1个月内手术史占比均低于验证组(P<0.05)。Logistic回归分析结果显示，慢性肾衰竭、机械通气、重度中性粒细胞降低、72 h内未接受抗真菌治疗、急性生理和慢性健康状况Ⅱ评分(APACHE Ⅱ)≥20分为念珠菌菌血症短期死亡的危险因素(P<0.05)，OR值分别为3.179、1.970、2.979、2.080、2.399，风险赋分分别为6、4、6、4、5。风险评分模型对建模组ROC曲线下面积(AUC)为0.792(95%CI 0.721~0.862)，Hosmer-Lemeshow(H-L)检验结果为P=0.305；验证组AUC为0.796(95%CI 0.735~0.898)，H-L检验结果为P=0.329。风险评分≤8分为短期死亡低风险组，评分9~15分为中风险组，评分≥16分为高风险组。结论 住院患者念珠菌菌血症发生率呈上升趋势，病死率较高；构建的念珠菌菌血症短期死亡风险预测评分模型预测效能较好。

念珠菌菌血症  /  药敏试验  /  危险因素  /  预测  /  评分模型

Objective To analyze the pathogenic characteristics and drug sensitivity of candidaemia, and construct a short-term mortality risk prediction scoring model. Methods The clinical data of patients with candidaemia admitted to the 909 Hospital of Joint Logistics Support Force from January 2011 to December 2020 were retrospectively analyzed, and the composition of pathogen composition, drug sensitivity test results and incidence of hospitalized patients were analyzed. 324 cases of candidaemia were randomly divided into modeling group (190 cases) and validation group (134 cases), and the risk factors were screened by binary logistic regression. According to the odds ratio (OR) score, the 30 day mortality risk prediction scoring model was constructed, and the predictive performance of the model was verified both in modeling and validation groups. Results 356 strains of Candida including 126 strains of C. albicans (35.39%), 79 strains of C. tropicalis (22.19%), 74 strains of C. parapsilosis (20.79%), 48 strains of C. glabrata (13.48%), 14 strains of C. guilliermondii (3.93%), 8 strains of C. krusei (2.25%), and 7 strains of other Candida (1.97%) were detected in 336 patients with candidemia. The incidence of candidaemia among hospitalized patients increased from 0.20 ‰ in 2011 to 0.48 ‰ in 2020. The resistance rate of candida to amphotericin B was significantly lower than that of fluconazole, voriconazole and itraconazole (P<0.05). Among the 324 cases included in the model, 95 patients died in 30 days after diagnosis, and the mortality rate was 29.32%. The proportion of males, fever, and parenteral nutrition in modeling group was significantly higher than that in validation group (P<0.05), while the proportion of chronic lung disease and surgical history within one month were lower than those in validation group (P<0.05). Logistic regression analysis showed that chronic renal failure, mechanical ventilation, severe neutropenia, failure to receive anti-fungal treatment within 72 hours, and APACHE Ⅱ ≥20 were risk factors for short-term death of candidaemia, the OR values were 3.179, 1.970, 2.979, 2.080, and 2.399, and the risk scores were 6, 4, 6, 4, and 5, respectively. The area under the curve (AUC) of the risk scoring model for modeling group was 0.792 (95%CI 0.721-0.862), and the result of Hosmer-Lemeshow (H-L) test was P=0.305; The AUC of validation group was 0.796 (95%CI 0.735-0.898), and the H-L test result was P=0.329. A risk score ≤8 indicated a low risk group for short-term mortality, a score of 9-15 indicated a medium risk group, and a score ≥16 indicated a high risk group. Conclusions The incidence of candidemia in hospitalized patients is increasing and the mortality is high. The risk prediction score model can effectively predict the short-term prognosis and facilitate the early identification of the prognosis.

candidaemia  /  drug sensitivity test  /  risk factors  /  prediction  /  scoring model
马建新, 林小强, 蔡明池, 许玉珍, 彭俊, 梁声强. 念珠菌菌血症病原菌特点及短期预后风险预测评分模型的构建与验证. 解放军医学杂志, 2024 , 49 (3) : 280 -287 . DOI: 10.11855/j.issn.0577-7402.1385.2023.0626
Jian-Xin Ma, Xiao-Qiang Lin, Ming-Chi Cai, Yu-Zhen Xu, Jun Peng, Sheng-Qiang Liang. Construction and validation of a scoring model for pathogen characteristics and short-term prognosis risk prediction of candidemia[J]. Medical Journal of Chinese People’s Liberation Army, 2024 , 49 (3) : 280 -287 . DOI: 10.11855/j.issn.0577-7402.1385.2023.0626
正文
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念珠菌菌血症是由侵袭性真菌引发的，多发生于免疫功能低下、长期接受免疫抑制剂治疗或长期应用广谱抗生素的患者，病死率为35%~53%[1]，是血流感染死亡的第四大病因[2]，且与较长的住院时间和较高的医疗支出密切相关。念珠菌菌血症高危患者早期没有特征性临床表现，识别比较困难，而盲目使用抗真菌药物会造成医疗成本增加，生物毒性、耐药及药物不良反应的风险增高[3]。国外有少量基于二元logistic回归构建念珠菌菌血症预后预测模型的研究报道，但这些预测模型计算量较大，临床适用性不强[4-5]。国内相关研究多集中于念珠菌菌血症、医院获得性念珠菌菌血症患者病原学特征或不良预后危险因素的分析[6-7]，但较少将危险因素转化为便于临床使用的模型。本研究回顾性分析本院收治的念珠菌菌血症病原菌构成和药敏特性，根据风险因素构建短期预后风险预测评估模型，并对构建的模型进行验证，旨在为临床念珠菌菌血症的早期风险评估提供可行的方案。
1 资料与方法
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1.1 研究对象
通过电子病历系统，选择2011年1月1日-2020年12月31日在联勤保障部队第909医院住院治疗的念珠菌菌血症患者336例，收集患者的人口学特征、临床资料及念珠菌药敏试验结果进行回顾性分析。念珠菌菌血症的诊断标准，参考欧洲癌症研究和治疗组织-感染性疾病协作组及真菌研究组教育与研究共同体联合发布的关于侵袭性真菌病定义共识[8]。多次感染的患者分析其所有念珠菌药敏试验结果，但只将首次血流感染时的临床资料纳入模型分析。排除念珠菌菌血症发生后30 d内失访的12例，将剩余的324例纳入模型分析。
1.2 血培养
在需氧和厌氧血液培养瓶分别接种每例患者10 ml血液，并在采集后1 h内送至实验室，采用Bactect 9120全自动血培养仪进行增菌培养，报警后取该标本行革兰染色，若镜检见到真菌孢子则转接血琼脂或沙堡弱培养基，35℃温箱孵育24~48 h。
1.3 真菌鉴定与药敏试验
观察培养基上单个菌落的形态和颜色，利用VITEK-2的API酵母鉴定卡进行鉴定，或采用MALDI-TOF MS进行微生物的质谱鉴定。采用ATB Fungus 3酵母样真菌药敏试验盒进行药敏试验，严格按照《全国临床检验操作规程》和试剂盒操作说明对所有念珠菌菌株进行氟康唑、伊曲康唑、伏立康唑和两性霉素B的抗真菌药敏试验。肉眼观察试验孔与生长对照孔，判读对应的最低抑菌浓度(minimum inhibitory concentration，MIC)值。质控菌株：近平滑念珠菌ATCC22019，克柔念珠菌ATCC6258。采用美国临床和实验室标准协会(Clinical and Laboratory Standards Institute，CLSI)M60[9]或欧洲抗菌药物敏感性试验委员会(European Committee for Antimicrobial Susceptibility Testing，EUCAST)定义的临床断点对药敏结果进行判断[10]。
1.4 定义
肠外营养、机械通气、中央静脉置管和介入操作均为确诊念珠菌菌血症后30 d内进行的治疗。发热是指确诊念珠菌菌血症后30 d内的临床表现。重度中性粒细胞降低[11]是指确诊念珠菌菌血症后30 d内中性粒细胞计数<0.5×109/L。慢性肾衰竭[12]指病史超过3个月，且肾小球滤过率<60 ml/min。
1.5 病例分组
本研究共纳入念珠菌菌血症324例，男228例，女96例，年龄(54.3±16.2)岁。其中，死亡95例，存活229例；将324例分别编号，采用随机数字表法抽取190例(死亡56例、存活134例)组成建模组；余下的134例(死亡39例，存活95例)组成验证组。利用建模组数据构建念珠菌菌血症短期死亡风险预测评分模型，采用建模组、验证组数据分别验证该模型的预测效能并进行风险分层。
1.6 短期死亡风险预测评分模型的构建
通过单因素分析，对念珠菌菌血症预后变量进行筛查，当P<0.05时纳入二元logistic回归分析，通过Back-Wald方法筛选变量，建立回归模型，识别独立影响因素。根据回归分析中比值比(ratio ratio，OR)值进行赋分，按照以往研究方法[13]，根据OR/0.5(四舍五入)确定危险因素的分值，以此构建风险预测评分模型。
1.7 统计学处理
采用SPSS 19.0软件进行统计分析。计数资料以例(%)表示，采用χ2检验；通过二元logistic回归分析判断念珠菌菌血症短期死亡的独立影响因素。根据风险预测模型，以是否短期死亡作为状态变量，评分为自变量，采用受试者工作曲线(ROC)评价模型区分度，Hosmer-Lemeshow (H-L)检验判断风险模型校准度。P<0.05为差异有统计学意义。
2 结果
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2.1 不同年度念珠菌检出情况
336例念珠菌菌血症患者共检出念珠菌356株，其中6例检出2株念珠菌，3例检出3株念珠菌，321例检出1株念珠菌，6例多次感染、共检出念珠菌14株。356株念珠菌中，白色念珠菌126株(35.39%)，热带念珠菌79株(22.19%)，近平滑念珠菌74株(20.79%)，光滑念珠菌48株(13.48%)，季也蒙念珠菌14株(3.93%)，克柔念珠菌8株(2.25%)，其他念珠菌7株(1.97%)。念珠菌菌血症患者发生率从2011年的0.20‰上升到2014年的0.36‰，2017年为0.26‰，2020年上升为0.48‰，发生率呈波动上升趋势(图1)。
2.2 念珠菌药敏试验结果
356株念珠菌中，除8株克柔念珠菌对氟康唑固有耐药外，另有36株念珠菌对氟康唑耐药，耐药率10.34%(36/348)，其中白色念珠菌5株，近平滑念珠菌3株，热带念珠菌26株，季也蒙念珠菌2株。对氟康唑敏感率最高为白色念珠菌(94.44%)，其次为近平滑念珠菌(91.89%)、季也蒙念珠菌(85.71%)。念珠菌对伏立康唑和伊曲康唑耐药率分别为7.87%、14.89%。念珠菌对两性霉素B耐药率较低，除光滑念珠菌2株对两性霉素B耐药外，其余均为敏感。念珠菌对两性霉素B耐药率明显低于氟康唑、伏立康唑和伊曲康唑(P<0.05，表1)。
2.3 建模组与验证组临床资料比较
纳入模型分析的念珠菌菌血症324例中，科室分布广泛，其中ICU、肿瘤内科、血液科、感染科较多，分别为113例(34.9%)、30例(9.3%)、29例(9.0%)、24例(7.4%)。其中建模组190例中，30 d内死亡56例，存活134例；验证组134例中，30 d内死亡39例，存活95例。建模组男性、发热、肠外营养占比明显高于验证组(P<0.05)，慢性肺病、1个月内手术史占比低于验证组(P<0.05)；两组间其余指标比较差异均无统计学意义(P>0.05，表2)。
2.4 30 d内死亡的单因素分析
将建模组190例根据确诊后30 d预后分为死亡组与存活组，单因素分析结果显示，慢性肾衰竭、机械通气、介入操作、重度中性粒细胞降低(<0.5×109/L)、72 h内未接受抗真菌治疗、急性生理和慢性健康状况Ⅱ评分(Acute Physiology and Chronic Health Evaluation，APACHE Ⅱ)≥20分与念珠菌菌血症患者30 d内死亡可能有关(P<0.05，表3)。
2.5 危险因素赋值和短期死亡风险预测模型的建立
将念珠菌菌血症患者30 d内死亡单因素分析中差异有统计学意义的变量纳入二元logistic回归分析，采用Back-Wald方法筛选变量，结果纳入模型的5个变量为慢性肾衰竭、机械通气、重度中性粒细胞降低、72 h内未接受抗真菌治疗、APACHE Ⅱ≥20分(P<0.05)，OR值分别为3.179(95%CI 1.312~10.540)、1.970(95%CI 1.042~3.727)、2.979(95%CI 1.212~7.319)、2.080(95%CI 1.057~4.091)、2.399(95%CI 1.133~5.082)。依据OR/0.5构建的30 d内死亡风险预测模型，慢性肾衰竭赋值6分，机械通气赋值4分，重度中性粒细胞降低赋值6分，72 h内未接受抗真菌治疗赋值4分，APACHE Ⅱ评分≥20分赋值5分(表4)。所有患者最低分为0分，最高分为25分。
2.6 30 d内死亡风险预测评分模型的验证
根据风险预测评分模型分别对建模组和验证组进行评分，并计算该分值下念珠菌菌血症患者的病死率，随着评分分值增加，患者病死率呈上升趋势(图2)。以建模组确诊后30 d内死亡作为状态变量，以风险评分值为检验变量绘制的ROC曲线显示，曲线下面积(area under the curve，AUC)为0.792(95%CI 0.721~0.862，P<0.05)，H-L检验结果为χ2=2.141，P=0.305，提示此风险评分模型具有较好的区分度和校准度(图3A)。采用相同的方法在验证组绘制的ROC曲线显示，AUC为0.796(95%CI 0.735~0.898，P<0.05)，H-L检验结果为χ2=2.011，P=0.329，提示该模型在验证组同样有较好的区分度和校准度(图3B)。
2.7 30 d死亡风险预测评分模型的建模组、验证组患者短期病死风险分层
计算建模组各分值对应的短期病死率，将患者进行风险分层。结果显示，建模组评分≤8分为低风险组，30 d病死率为4.17%；评分9~15分为中风险组，30 d病死率为23.91%；评分≥16分为高风险组，30 d病死率为64.00%；各风险层病死率差异明显(χ2=44.831，P=0.000)，其中高风险组病死率明显高于低风险组和中风险组(χ2=38.696、22.089，P<0.001)，中风险组病死率高于低风险组(χ2=8.659，P=0.003)。
按照建模组风险分层标准，验证组评分≤8分为低风险组，30 d病死率为4.00%；评分9~15分为中风险组，30 d病死率为24.00%；评分≥16分为高风险组，30 d病死率为58.82%；各风险层病死率差异明显(χ2=23.137，P=0.000)，其中高风险组病死率高于低风险组和中风险组(χ2=18.889、12.493，P=0.000)，中风险组病死率高于低风险组(χ2=4.873，P=0.027)。建模组、验证组相同风险分层病死率比较差异无统计学意义(χ2=0.001、<0.001、0.230，P>0.05，图4)。
3 讨论
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随着广谱抗生素、免疫抑制剂和糖皮质激素广泛使用[14-16]，以及恶性肿瘤、白血病、艾滋病的增多，念珠菌菌血症发病率逐年上升[17]，病死率可达50%。本研究显示10年时间内，本院住院患者念珠菌菌血症发病率呈波动上升的趋势，与国内外多家研究机构报道结果相近[18-19]。因此，全面了解念珠菌菌血症患者致病菌和药敏特征，构建短期死亡风险预测模型，对于高危患者识别、抗真菌药物选择及治疗结局的改善有重要意义。
念珠菌菌血症流行菌株随地区不同有较大差异。Wang等[20]认为北欧国家以白色念珠菌为主，美国和多数亚洲国家以非白色念珠菌为主；非白色念珠菌中，中国以近平滑念珠菌占比较高。本研究结果显示白色念珠菌占比较高，但近10年来，白色念珠菌占比呈波动下降趋势，非白色念珠菌占比呈升高趋势；非白色念珠菌中近平滑念珠菌占比较高。热带念珠菌菌血症多发生于癌症或恶性血液病患者。克柔念珠菌则易发于恶性血液病和移植患者[21]，临床检出率较低。
根据2016年美国感染性疾病协会发布的念珠菌处置和临床实践指南[22]，棘白菌素类、氟康唑为初始经验性治疗的一线药物。本研究显示，5种抗真菌药物中，氟康唑、伊曲康唑的念珠菌耐药率较高，而两性霉素B和伏立康唑的念珠菌耐药率较低，因此，建议临床考虑将棘白菌素类作为初始的一线用药。以往大量研究显示，入住ICU、序贯器官衰竭评分(sequential organ failure assessment，SOFA)高、念珠菌菌血症持续时间长、机械通气、器官衰竭等均为念珠菌菌血症患者死亡的高危因素[23-24]。良好的预测模型应具有较高的预测灵敏度、特异度及操作简便等特点，但以上研究报道仅对危险因素进行分析，并未将危险因素进行建模，临床可操作性较低。本研究结果显示，慢性肾衰竭、机械通气、重度中性粒细胞降低、72 h内未进行抗真菌治疗、APACHEⅡ≥20分均为念珠菌菌血症患者短期死亡的独立危险因素。目前，对于早期抗真菌治疗是否能有效降低患者病死率存在一定争议。Trifi等[25]研究显示，抗真菌治疗对28 d生存率或预防非中性粒细胞减少性败血症危重症患者念珠菌病的死亡无有益影响。Taur等[26]认为APACHE Ⅱ评分高影响念珠菌菌血症患者短期生存率，而初始抗真菌药物的选择不影响患者短期生存率；Tedeschi等[27]提出了相反的观点，认为72 h内采用抗真菌治疗可有效降低患者病死率。本研究中27.4%的患者未采用早期抗真菌治疗，此类患者短期病死率明显高于早期抗真菌治疗的患者，早期抗真菌治疗是患者短期死亡的保护性因素。考虑到以上变量与念珠菌菌血症患者短期病死率的关系，对以上变量通过OR/0.5进行赋分，建立短期死亡风险预测评分模型。本研究通过ROC曲线和H-L检验判断该模型的区分度和校准度。建模组、验证组数据验证结果均提示该模型具有较好的风险评估预测效能。
本研究为回顾性研究，仅分析了本院收治的念珠菌菌血症患者的临床特征，标本量相对较小，部分患者的临床资料中C反应蛋白(C-reactive protein，CRP)、降钙素原(procalcitonin，PCT)、(1,3)-β-D葡聚糖等指标不全，因此未将上述指标纳入统计分析；风险预测评分模型建立后未进行外部数据的验证。以上不足有待启动多中心和后续临床验证加以优化。
综上所述，根据念珠菌菌血症患者相关危险因素的回归分析而建立的短期死亡风险预测评分模型，当患者评分≤8分时，为短期不良预后低风险人群；当评分9~15分时，为短期不良预后中风险人群；当评分≥16分时，为短期不良预后高风险人群。该风险预测评分模型可用于念珠菌菌血症短期临床结局的预测评估。
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  • 军队军事科学装备科研项目(JK20191A040324)
  • 漳州市拥军课题(ZZ2020KD04)
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2024年第49卷第3期
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doi: 10.11855/j.issn.0577-7402.1385.2023.0626
  • 接收时间：2022-06-21
  • 首发时间：2025-11-23
  • 出版时间：2024-03-28
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  • 收稿日期：2022-06-21
  • 录用日期：2022-08-28
基金
Military Equipment Scientific Research Project of PLA(JK20191A040324)
军队军事科学装备科研项目(JK20191A040324)
Science and Technology Military Support Project of Zhangzhou(ZZ2020KD04)
漳州市拥军课题(ZZ2020KD04)
作者信息
    1解放军联勤保障部队第909医院(厦门大学附属东南医院)检验科，福建漳州 363000
    2中南大学湘雅医学院附属株洲医院检验科，湖南株洲 413007

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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