Risk factors for invasive fungal disease in critically ill, adult patients: a systematic review.
Crit Care. 2011 Nov 29;15(6):R287
Authors: Muskett H, Shahin J, Eyres G, Harvey S, Rowan K, Harrison D
ABSTRACT: INTRODUCTION: Over 5,000 cases of invasive Candida species infections occur in the UK each year and around 40% of these occur in critical care units. Invasive fungal disease (IFD) in critically-ill patients is associated with increased morbidity and mortality at a cost to both the individual and the health service. This paper reports the results of a systematic review performed to identify and summarise the important risk factors from published multivariable analyses, risk prediction models and clinical decision rules, for IFD in critically ill, adult patients to inform the primary data collection for the Fungal Infection Risk Evaluation (FIRE) Study. METHODS: An electronic search was performed to identify articles which investigated risk factors, risk prediction models or clinical decisions rules for IFD in critically ill, adult patients. Eligible articles were identified in a staged process and were assessed by two investigators, independently. The methodological quality of the reporting of the eligible articles was assessed using a set of questions addressing both general and statistical methodology. RESULTS: Thirteen articles met the inclusion criteria, of which eight articles examined risk factors, four developed a risk prediction model or clinical decision rule, and one evaluated a clinical decision rule. Studies varied in terms of objectives, risk factors, definitions and outcomes. The following risk factors were found in multiple studies to be significantly associated with IFD: surgery, total parenteral nutrition, fungal colonisation, renal replacement therapy, infection/sepsis, mechanical ventilation, diabetes, and APACHE II or APACHE III score. Several other risk factors were also found to be statistically significant in single studies only. Risk factor selection process and modelling strategy also varied across studies, and sample sizes were inadequate for obtaining reliable estimates. CONCLUSION: This review has shown a number of risk factors to be significantly associated with the development of IFD in critically ill adults. Methodological limitations were identified in the design and conduct of studies in this area, and caution should be used in their interpretation.
PMID: 22126425 [PubMed - as supplied by publisher]