J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 8, Number 4, April 2016, pages 303-311

Temporal Trends of the Clinical, Resource Use and Outcome Attributes of ICU-Managed Candidemia Hospitalizations: A Population-Level Analysis

**Table 1.** The Demographics and Health Insurance Characteristics of C-ICU Hospitalizations, 2001 - 2010
Group	n = 7,552
^aPercent figures are rounded. ^bGender was masked in 575 hospitalizations. The denominator used to derive gender percentages for the cohort was based on hospitalizations with available gender designation (n = 6,977).
Age (years), n (%)^a
18 - 44	1,177 (15.6)
45 - 64	2,774 (36.7)
≥ 65	3,601 (47.7)
Male, n (%)^{a, b}	3,242 (46.5)
Race/ethnicity, n (%)^a
White	3,840 (50.8)
Hispanic	1,590 (21.1)
Black	1,512 (20.0)
Other	591 (7.8)
Missing	1 (0.3)
Health insurance, n (%)^a
Private	1,973 (26.1)
Medicare	4,212 (55.8)
Medicaid	770 (10.2)
Uninsured	478 (6.3)
Other	118 (1.6)
Missing	1 (0.3)

Table 1. The Demographics and Health Insurance Characteristics of C-ICU Hospitalizations, 2001 - 2010

Group

n = 7,552

^aPercent figures are rounded. ^bGender was masked in 575 hospitalizations. The denominator used to derive gender percentages for the cohort was based on hospitalizations with available gender designation (n = 6,977).

Age (years), n (%)^a

18 - 44

1,177 (15.6)

45 - 64

2,774 (36.7)

≥ 65

3,601 (47.7)

Male, n (%)^{a, b}

3,242 (46.5)

Race/ethnicity, n (%)^a

White

3,840 (50.8)

Hispanic

1,590 (21.1)

Black

1,512 (20.0)

Other

591 (7.8)

Missing

1 (0.3)

Health insurance, n (%)^a

Private

1,973 (26.1)

Medicare

4,212 (55.8)

Medicaid

770 (10.2)

Uninsured

478 (6.3)

Other

118 (1.6)

Missing

1 (0.3)

**Table 2.** Select Demographic Characteristics, Health Insurance, and Comorbidities of C-ICU Hospitalizations, 2001 - 2010
Group	2001 - 2002 (n = 905)	2003 - 2004 (n = 1,114)	2005 - 2006 (n = 1,752)	2007 - 2008 (n = 1,829)	2009 - 2010 (n = 1,952)	AAPC (95% CI)^a	P-value
^aAAPC: average annual percent change (95% confidence intervals). ^bThe denominator used to derive male percentage for the cohort was based on hospitalizations with available gender designation. ^cMean (standard deviation). ^dBased on the Charlson-Deyo comorbidity index.
Male^b n, (%)	381 (45.7)	439 (42.3)	795 (49.8)	776 (46.1)	851 (47)	0.6 (-0.9 to 2.2)	0.3729
Age ≥ 65 years, n (%)	460 (50.8)	527 (47.3)	861 (49.1)	863 (47.2)	890 (45.6)	-1.0 (-2.0 to -0.1)	0.0382
Health insurance, n (%)
Private	200 (22.1)	266 (23.9)	429 (24.5)	510 (27.9)	570 (29.2)	3.6 (2.3 to 5.0)	0.0002
Medicare	540 (59.7)	610 (54.8)	1,050 (59.9)	995 (54.4)	1017 (52.1)	-1.3 (-2.5 to -0.2)	0.0245
Medicaid	69 (7.6)	133 (11.9)	165 (9.4)	189 (10.3)	214 (11.0)	3.0 (-2.0 to 7.9)	0.2090
Uninsured	51 (5.6)	79 (7.1)	88 (5.0)	125 (6.8)	135 (6.9)	1.6 (-2.7 to 5.9)	0.4079
Other	45 (5.0)	25 (2.2)	22 (1.3)	10 (0.5)	16 (0.8)	-29.0 (-43.9 to -14.1)	0.0020
Charlson-Deyo comorbidity index^c	2.3 (2.3)	2.1 (2.1)	3.0 (2.6)	3.2 (2.6)	2.9 (2.5)	4.2 (1.1 to 7.3)	0.0136
Comorbidities^d, n (%)
One or more comorbidity	699 (77.2)	858 (77.0)	1,494 (85.3)	1,577 (86.2)	1,653 (84.7)	1.4 (0.3 to 2.5)	0.0179
Myocardial infarction	55 (6.1)	62 (5.6)	141 (8.0)	171 (9.3)	190 (9.7)	7.1 (1.4 to 12.8)	0.0202
Congestive heart failure	222 (24.5)	289 (25.9)	643 (36.7)	584 (31.9)	519 (26.6)	1.6 (-2.7 to 5.90)	0.4177
Cerebrovascular disease	59 (6.5)	80 (7.2)	232 (13.2)	244 (13.3)	288 (14.8)	10.8 (5.8 to 15.8)	0.0011
Peripheral vascular disease	55 (6.1)	61 (5.5)	164 (9.4)	252 (13.8)	245 (12.6)	11.3 (4.8 to 17.8)	0.0038
Chronic lung disease	192 (21.2)	225 (20.2)	491 (28.0)	438 (23.9)	414 (21.2)	0.6 (-3.1 to 4.4)	0.7102
Connective tissue disease	23 (2.5)	32 (2.9)	51 (2.9)	64 (3.5)	67 (3.4)	3.3 (-1.1 to -7.7)	0.1198
Diabetes mellitus	121 (13.4)	124 (11.1)	429 (24.5)	545 (29.8)	520 (26.6)	11.3 (4.0 to 18.6)	0.0071
Renal disease	136 (15.0)	194 (17.4)	491 (28)	570 (31.2)	555 (28.4)	9.4 (5.2 to 13.6)	0.0009
Liver disease	73 (8.1)	90 (8.1)	217 (12.4)	256 (14.0)	311 (15.9)	9.1 (4.7 to 13.4)	0.0014
Malignancy	162 (17.9)	177 (15.9)	302 (17.2)	319 (17.4)	271 (13.9)	-1.6 (-5.0 to 1.7)	0.2971

Table 2. Select Demographic Characteristics, Health Insurance, and Comorbidities of C-ICU Hospitalizations, 2001 - 2010

Group

2001 - 2002 (n = 905)

2003 - 2004 (n = 1,114)

2005 - 2006 (n = 1,752)

2007 - 2008 (n = 1,829)

2009 - 2010 (n = 1,952)

AAPC (95% CI)^a

P-value

^aAAPC: average annual percent change (95% confidence intervals). ^bThe denominator used to derive male percentage for the cohort was based on hospitalizations with available gender designation. ^cMean (standard deviation). ^dBased on the Charlson-Deyo comorbidity index.

Male^b n, (%)

381 (45.7)

439 (42.3)

795 (49.8)

776 (46.1)

851 (47)

0.6 (-0.9 to 2.2)

0.3729

Age ≥ 65 years, n (%)

460 (50.8)

527 (47.3)

861 (49.1)

863 (47.2)

890 (45.6)

-1.0 (-2.0 to -0.1)

0.0382

Health insurance, n (%)

Private

200 (22.1)

266 (23.9)

429 (24.5)

510 (27.9)

570 (29.2)

3.6 (2.3 to 5.0)

0.0002

Medicare

540 (59.7)

610 (54.8)

1,050 (59.9)

995 (54.4)

1017 (52.1)

-1.3 (-2.5 to -0.2)

0.0245

Medicaid

69 (7.6)

133 (11.9)

165 (9.4)

189 (10.3)

214 (11.0)

3.0 (-2.0 to 7.9)

0.2090

Uninsured

51 (5.6)

79 (7.1)

88 (5.0)

125 (6.8)

135 (6.9)

1.6 (-2.7 to 5.9)

0.4079

Other

45 (5.0)

25 (2.2)

22 (1.3)

10 (0.5)

16 (0.8)

-29.0 (-43.9 to -14.1)

0.0020

Charlson-Deyo comorbidity index^c

2.3 (2.3)

2.1 (2.1)

3.0 (2.6)

3.2 (2.6)

2.9 (2.5)

4.2 (1.1 to 7.3)

0.0136

Comorbidities^d, n (%)

One or more comorbidity

699 (77.2)

858 (77.0)

1,494 (85.3)

1,577 (86.2)

1,653 (84.7)

1.4 (0.3 to 2.5)

0.0179

Myocardial infarction

55 (6.1)

62 (5.6)

141 (8.0)

171 (9.3)

190 (9.7)

7.1 (1.4 to 12.8)

0.0202

Congestive heart failure

222 (24.5)

289 (25.9)

643 (36.7)

584 (31.9)

519 (26.6)

1.6 (-2.7 to 5.90)

0.4177

Cerebrovascular disease

59 (6.5)

80 (7.2)

232 (13.2)

244 (13.3)

288 (14.8)

10.8 (5.8 to 15.8)

0.0011

Peripheral vascular disease

55 (6.1)

61 (5.5)

164 (9.4)

252 (13.8)

245 (12.6)

11.3 (4.8 to 17.8)

0.0038

Chronic lung disease

192 (21.2)

225 (20.2)

491 (28.0)

438 (23.9)

414 (21.2)

0.6 (-3.1 to 4.4)

0.7102

Connective tissue disease

23 (2.5)

32 (2.9)

51 (2.9)

64 (3.5)

67 (3.4)

3.3 (-1.1 to -7.7)

0.1198

Diabetes mellitus

121 (13.4)

124 (11.1)

429 (24.5)

545 (29.8)

520 (26.6)

11.3 (4.0 to 18.6)

0.0071

Renal disease

136 (15.0)

194 (17.4)

491 (28)

570 (31.2)

555 (28.4)

9.4 (5.2 to 13.6)

0.0009

Liver disease

73 (8.1)

90 (8.1)

217 (12.4)

256 (14.0)

311 (15.9)

9.1 (4.7 to 13.4)

0.0014

Malignancy

162 (17.9)

177 (15.9)

302 (17.2)

319 (17.4)

271 (13.9)

-1.6 (-5.0 to 1.7)

0.2971

**Table 3.** Organ Failure and Healthcare Resource Utilization Patterns of C-ICU Hospitalizations, 2001 - 2010
Group	2001 - 2002 (n = 905)	2003 - 2004 (n = 1,114)	2005 - 2006 (n = 1,752)	2007 - 2008 (n = 1,829)	2009 - 2010 (n = 1,952)	AAPC (95% CI)^a	P-value
^aAAPC: average annual percent change (95% confidence intervals). ^bMean (standard deviation). ^cMedian (interquartile range); hospital charges are adjusted for inflation (2010 dollars).
Organ failure^b	1.4 (1.1)	1.3 (1.1)	2.0 (1.5)	2.2 (1.6)	2.4 (1.6)	8.1 (5.2 to 10.9)	0.0002
Any organ failure (%)	684 (75.6)	818 (73.4)	1,473 (84.1)	1,585 (86.7)	1,707 (87.4)	2.3 (1.4 to 3.3)	0.0005
Three or more organ failures (%)	132 (14.6)	155 (13.9)	603 (34.4)	673 (36.8)	844 (43.2)	15.5 (9.2 to 21.7)	0.0004
Respiratory (%)	516 (57.0)	602 (54.0)	1,101 (62.8)	1,168 (63.9)	1,273 (65.2)	2.1 (0.9 to 3.3)	0.0039
Cardiovascular (%)	156 (17.2)	200 (18.0)	590 (33.7)	692 (37.8)	779 (39.9)	12.4 (7.9 to 16.9)	0.0002
Renal (%)	270 (29.8)	306 (27.5)	696 (39.7)	811 (44.3)	994 (50.9)	7.5 (4.8 to 10.30	0.0002
Hepatic (%)	33 (3.6)	34 (3.1)	112 (6.4)	149 (8.1)	182 (9.3)	13.9 (6.7 to 21.0)	0.0021
Hematological (%)	117 (12.3)	155 (13.9)	416 (23.7)	446 (24.4)	454 (23.3)	8.7 (4.2 to 13.10	0.0020
Metabolic (%)	87 (9.6)	94 (8.4)	303 (17.3)	355 (19.4)	366 (18.8)	10.8 (4.9 to 16.6)	0.0028
Neurological (%)	47 (5.2)	40 (3.6)	272 (15.5)	368 (20.1)	543 (27.8)	24.9 (14.5 to 35.3)	0.0006
Mechanical ventilation (%)	368 (40.7)	427 (38.3)	839 (47.9)	885 (48.4)	905 (46.4)	2.5 (0.6 to 4.4)	0.0155
New hemodialysis (%)	40 (4.4)	48 (4.3 )	177 (10.1)	205 (11.2)	220 (11.3)	13.7 (6.6 to 20.7)	0.0021
Central venous catheterization (%)	422 (46.6)	534 (47.9)	1,082 (61.8)	1,136 (62.1)	1,237 (63.4)	4.3 (2.6 to 6.1)	0.0004
Hospital length of stay (days)^b	33.2 (27.8)	31.2 (23.8)	33.0 (26.6)	33.4 (31.7)	32.2 (32.1)	-0.1 (-1.0 to 0.9)	0.9226
Total hospital charges (dollars)^c	226,997 (108,200 - 470,594)	218,094 (115,397 - 401,271)	227,336 (126,166 - 393,787)	235,205 (123,707 - 400,408)	235,457 (120,512 - 433,173)	0.8 (-0.1 to 1.8)	0.0720

Table 3. Organ Failure and Healthcare Resource Utilization Patterns of C-ICU Hospitalizations, 2001 - 2010

Group

2001 - 2002 (n = 905)

2003 - 2004 (n = 1,114)

2005 - 2006 (n = 1,752)

2007 - 2008 (n = 1,829)

2009 - 2010 (n = 1,952)

AAPC (95% CI)^a

P-value

^aAAPC: average annual percent change (95% confidence intervals). ^bMean (standard deviation). ^cMedian (interquartile range); hospital charges are adjusted for inflation (2010 dollars).

Organ failure^b

1.4 (1.1)

1.3 (1.1)

2.0 (1.5)

2.2 (1.6)

2.4 (1.6)

8.1 (5.2 to 10.9)

0.0002

Any organ failure (%)

684 (75.6)

818 (73.4)

1,473 (84.1)

1,585 (86.7)

1,707 (87.4)

2.3 (1.4 to 3.3)

0.0005

Three or more organ failures (%)

132 (14.6)

155 (13.9)

603 (34.4)

673 (36.8)

844 (43.2)

15.5 (9.2 to 21.7)

0.0004

Respiratory (%)

516 (57.0)

602 (54.0)

1,101 (62.8)

1,168 (63.9)

1,273 (65.2)

2.1 (0.9 to 3.3)

0.0039

Cardiovascular (%)

156 (17.2)

200 (18.0)

590 (33.7)

692 (37.8)

779 (39.9)

12.4 (7.9 to 16.9)

0.0002

Renal (%)

270 (29.8)

306 (27.5)

696 (39.7)

811 (44.3)

994 (50.9)

7.5 (4.8 to 10.30

0.0002

Hepatic (%)

33 (3.6)

34 (3.1)

112 (6.4)

149 (8.1)

182 (9.3)

13.9 (6.7 to 21.0)

0.0021

Hematological (%)

117 (12.3)

155 (13.9)

416 (23.7)

446 (24.4)

454 (23.3)

8.7 (4.2 to 13.10

0.0020

Metabolic (%)

87 (9.6)

94 (8.4)

303 (17.3)

355 (19.4)

366 (18.8)

10.8 (4.9 to 16.6)

0.0028

Neurological (%)

47 (5.2)

40 (3.6)

272 (15.5)

368 (20.1)

543 (27.8)

24.9 (14.5 to 35.3)

0.0006

Mechanical ventilation (%)

368 (40.7)

427 (38.3)

839 (47.9)

885 (48.4)

905 (46.4)

2.5 (0.6 to 4.4)

0.0155

New hemodialysis (%)

40 (4.4)

48 (4.3 )

177 (10.1)

205 (11.2)

220 (11.3)

13.7 (6.6 to 20.7)

0.0021

Central venous catheterization (%)

422 (46.6)

534 (47.9)

1,082 (61.8)

1,136 (62.1)

1,237 (63.4)

4.3 (2.6 to 6.1)

0.0004

Hospital length of stay (days)^b

33.2 (27.8)

31.2 (23.8)

33.0 (26.6)

33.4 (31.7)

32.2 (32.1)

-0.1 (-1.0 to 0.9)

0.9226

Total hospital charges (dollars)^c

226,997 (108,200 - 470,594)

218,094 (115,397 - 401,271)

227,336 (126,166 - 393,787)

235,205 (123,707 - 400,408)

235,457 (120,512 - 433,173)

0.8 (-0.1 to 1.8)

0.0720

**Table 4.** Discharge Disposition of C-ICU Hospitalizations, 2001 - 2010
Group (%)^b	2001 - 2002 (n = 905)	2003 - 2004 (n = 1,114)	2005 - 2006 (n = 1,752)	2007 - 2008 (n = 1,829)	2009 - 2010 (n = 1,952)	AAPC (95% CI)^a	P-value
^aAAPC: average annual percent change (95% confidence interval). ^bPercent figures are rounded. ^cEnd-of-life hospitalizations were those with either hospital death or discharge to hospice. ^dExamination of annual changes was limited to the years 2003 - 2010, as the first discharges to a long-term care facility were reported in 2003. ^eLeave against medical advice and unknown discharge destination.
End-of-life hospitalizations^c	367 (40.6)	381 (34.2)	681 (38.9)	641 (35.0)	617 (31.6)	-2.4 (-4.5 to -0.2)	0.0349
Death	355 (39.2)	342 (30.7)	569 (32.5)	500 (27.3)	487 (24.9)	-5.2 (-7.4 to -3.0)	0.0006
Hospice	12 (1.3)	39 (3.5)	112 (6.4)	141 (7.7)	130 (6.7)	24.0 (10.6 to 37.5)	0.0033
Home	241 (26.6)	338 (30.3)	390 (22.3)	443 (24.2)	453 (23.2)	-2.5 (-5.2 to 0.2)	0.0667
Routine home	178 (19.7)	187 (16.8)	201 (11.5)	230 (12.6)	230 (11.8)	-6.5 (-10.0 to -3.0)	0.0025
Home health care	63 (7.0)	151 (13.6)	189 (10.8)	213 (11.6)	223 (11.4)	3.9 (-1.9 to 9.7)	0.1566
Another hospital	111 (12.3)	250 (22.4)	440 (25.1)	490 (26.8)	578 (29.6)	9.5 (2.5 to 16.5)	0.0143
Long-term care hospital^d	-	123 (11.0)	208 (11.9)	349 (19.1)	391 (20.0)	11.9 (6.4 to 17.5)	0.0019
Nursing facility	138 (15.2)	138 (12.4)	233 (13.3)	245 (13.4)	286 (14.7)	0.2 (-3.0 to 3.4)	0.9081
Other^e	48 (5.3)	7 (0.6)	8 (0.5)	10 (0.5)	18 (0.9)	-11.3 (-34.8 to 12.1)	0.2972

Table 4. Discharge Disposition of C-ICU Hospitalizations, 2001 - 2010

Group (%)^b

2001 - 2002 (n = 905)

2003 - 2004 (n = 1,114)

2005 - 2006 (n = 1,752)

2007 - 2008 (n = 1,829)

2009 - 2010 (n = 1,952)

AAPC (95% CI)^a

P-value

^aAAPC: average annual percent change (95% confidence interval). ^bPercent figures are rounded. ^cEnd-of-life hospitalizations were those with either hospital death or discharge to hospice. ^dExamination of annual changes was limited to the years 2003 - 2010, as the first discharges to a long-term care facility were reported in 2003. ^eLeave against medical advice and unknown discharge destination.

End-of-life hospitalizations^c

367 (40.6)

381 (34.2)

681 (38.9)

641 (35.0)

617 (31.6)

-2.4 (-4.5 to -0.2)

0.0349

Death

355 (39.2)

342 (30.7)

569 (32.5)

500 (27.3)

487 (24.9)

-5.2 (-7.4 to -3.0)

0.0006

Hospice

12 (1.3)

39 (3.5)

112 (6.4)

141 (7.7)

130 (6.7)

24.0 (10.6 to 37.5)

0.0033

Home

241 (26.6)

338 (30.3)

390 (22.3)

443 (24.2)

453 (23.2)

-2.5 (-5.2 to 0.2)

0.0667

Routine home

178 (19.7)

187 (16.8)

201 (11.5)

230 (12.6)

230 (11.8)

-6.5 (-10.0 to -3.0)

0.0025

Home health care

63 (7.0)

151 (13.6)

189 (10.8)

213 (11.6)

223 (11.4)

3.9 (-1.9 to 9.7)

0.1566

Another hospital

111 (12.3)

250 (22.4)

440 (25.1)

490 (26.8)

578 (29.6)

9.5 (2.5 to 16.5)

0.0143

Long-term care hospital^d

123 (11.0)

208 (11.9)

349 (19.1)

391 (20.0)

11.9 (6.4 to 17.5)

0.0019

Nursing facility

138 (15.2)

138 (12.4)

233 (13.3)

245 (13.4)

286 (14.7)

0.2 (-3.0 to 3.4)

0.9081

Other^e

48 (5.3)

7 (0.6)

8 (0.5)

10 (0.5)

18 (0.9)

-11.3 (-34.8 to 12.1)

0.2972