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 3, Number 2, April 2011, pages 65-71

Septic Shock Due to Candidemia: Outcomes and Predictors of Shock Development

Figure 2.. Receiver operator curves for the three predictors with statistical significance. Closed circles: ROC for time in ICU prior to candidemia; Open circles: ROC for ICU length of stay (LOS); Open diamonds: ROC for hospital LOS

**Table 1.** Patients With Candidemia Associated Septic Shock: Characteristics and Outcome
Age	Sex	ICU admission diagnosis	Candida spp.	Predisposing factors for candidiasis	Outcome
CRF: chronic renal failure; DM: diabetes mellitus; PN: parenteral nutrition; Liver Ds: liver disease; D/C: discharged; LTACH: long term acute care hospital
50	Male	Septic shock	Albicans	Yes	---	---	---	Yes	Deceased
71	Female	Post cecal mass resection	Albicans	Yes	Yes	---	---	---	Deceased
84	Male	Post exploratory laparotomy for colonic perforation	Albicans	---	Yes	Yes	Yes	---	Deceased
83	Female	Septic shock	Albicans	---	---	---	---	---	Deceased
59	Male	Gastrointestinal bleeding (admitted to the hospital with urosepsis)	Albicans	---	---	---	Yes	Yes	Deceased
63	Male	Aspiration pneumonia	Glabrata	---	---	Yes	---	---	D/C LTACH
54	Female	Post clipping of cerebral aneurysm	Glabrata	---	Yes	---	---	---	D/C Rehab
77	Male	Respiratory failure-pneumonia	Glabrata	---	Yes	---	---	---	Deceased
74	Male	Gastrointestinal bleeding	Glabrata	Yes	Yes	---	---	---	Deceased
50	Female	Endobronchial radiation treatment	Glabrata	Yes	---	---	---	---	Deceased
56	Female	Post exploratory laparotomy (colon and stomach resection)	Glabrata	Yes	---	---	---	---	Deceased
40	Female	Sepsis - neutropenia	Lusitaniae	Yes	---	---	---	---	Deceased
64	Male	Septic shock	Albicans	Yes	Yes	---	---	---	Deceased
57	Male	Respiratory failure post peripheral stem cell transplant	Glabrata	Yes	Yes	---	---	---	Deceased
51	Female	Neutropenic fever and septic shock	Glabrata	Yes	Yes	---	---	---	Deceased

Table 1. Patients With Candidemia Associated Septic Shock: Characteristics and Outcome

Age

Sex

ICU admission diagnosis

Candida spp.

Predisposing factors for candidiasis

Outcome

Cancer

CRF

Liver Ds

CRF: chronic renal failure; DM: diabetes mellitus; PN: parenteral nutrition; Liver Ds: liver disease; D/C: discharged; LTACH: long term acute care hospital

Male

Septic shock

Albicans

Yes

---

Yes

Deceased

Female

Post cecal mass resection

Albicans

Yes

---

Deceased

Male

Post exploratory laparotomy for colonic perforation

Albicans

---

Yes

---

Deceased

Female

Septic shock

Albicans

---

Deceased

Male

Gastrointestinal bleeding (admitted to the hospital with urosepsis)

Albicans

---

Yes

Deceased

Male

Aspiration pneumonia

Glabrata

---

Yes

---

D/C LTACH

Female

Post clipping of cerebral aneurysm

Glabrata

---

Yes

---

D/C Rehab

Male

Respiratory failure-pneumonia

Glabrata

---

Yes

---

Deceased

Male

Gastrointestinal bleeding

Glabrata

Yes

---

Deceased

Female

Endobronchial radiation treatment

Glabrata

Yes

---

Deceased

Female

Post exploratory laparotomy (colon and stomach resection)

Glabrata

Yes

---

Deceased

Female

Sepsis - neutropenia

Lusitaniae

Yes

---

Deceased

Male

Septic shock

Albicans

Yes

---

Deceased

Male

Respiratory failure post peripheral stem cell transplant

Glabrata

Yes

---

Deceased

Female

Neutropenic fever and septic shock

Glabrata

Yes

---

Deceased

**Table 2.** Patient Age, Acuity, Outcomes and Lengths of Stay
	All Candidemias (n = 50)	No shock (n = 35)	Shock (n = 15)	P Value
LOS: Length of stay
Age (years)	61 ± 14	60 ± 14	62 ± 13	0.64
Apache II	22.6 ± 8.3	21.1 ± 7.2	26.5 ± 9.7	0.04
Mortality (%)	76	71	87	0.30
Hospital LOS (days)	35.6 ± 19.8	40.1 ± 19.1	25.1 ± 17.9	0.01
ICU LOS (days)	22.0 ± 16.0	24.0 ± 16.5	17.4 ± 14.3	0.18
Hospital LOS prior to ICU (days)	7.9 ± 10.5	9.3 ± 11.5	4.4 ± 6.7	0.13
Time in ICU prior to candidemia	13.5 ± 13.2	16.9 ± 14.4	5.5 ± 3.8	0.004
Documented colonization (patients)	22 (44%)	18 (51%)	4 (27%)	0.13
Candida spp. patients (%)
Albicans	14 (26%)	8 (23%)	6 (40%)	0.30
Non-albicans	36 (74%)	27 (77%)	9 (60%)
Time to clearance (days)	8.6 ± 8.3	7.4 ± 7.9	9.0 ± 8.6	0.64

Table 2. Patient Age, Acuity, Outcomes and Lengths of Stay

All Candidemias
(n = 50)

No shock
(n = 35)

Shock
(n = 15)

P Value

LOS: Length of stay

Age (years)

61 ± 14

60 ± 14

62 ± 13

0.64

Apache II

22.6 ± 8.3

21.1 ± 7.2

26.5 ± 9.7

0.04

Mortality (%)

0.30

Hospital LOS (days)

35.6 ± 19.8

40.1 ± 19.1

25.1 ± 17.9

0.01

ICU LOS (days)

22.0 ± 16.0

24.0 ± 16.5

17.4 ± 14.3

0.18

Hospital LOS prior to ICU (days)

7.9 ± 10.5

9.3 ± 11.5

4.4 ± 6.7

0.13

Time in ICU prior to candidemia

13.5 ± 13.2

16.9 ± 14.4

5.5 ± 3.8

0.004

Documented colonization (patients)

22 (44%)

18 (51%)

4 (27%)

0.13

Candida spp. patients (%)

Albicans

14 (26%)

8 (23%)

6 (40%)

0.30

Non-albicans

36 (74%)

27 (77%)

9 (60%)

Time to clearance (days)

8.6 ± 8.3

7.4 ± 7.9

9.0 ± 8.6

0.64

**Table 3.** Multiple Logistic Regression Analysis
	Odds ratio	95% CI	P Value
Hosmer-Lemeshow statistic: 3.175 (P = 0.923); Likelihood ratio test statistic: 28.474 (P ≤ 0.001)ICU: Intensive care unit; APACHE: Acute Physiology and Chronic Health Evaluation; LOS: Length of stay
APACHE II score	1.007	0.882 - 1.149	0.919
Hospital LOS	0.902	0.805 - 1.010	0.075
ICU LOS	1.119	0.988 - 1.267	0.076
Hospital LOS before ICU	0.965	0.819 - 1.138	0.675
ICU LOS prior to candidemia	0.714	0.531 - 0.960	0.026
Candida colonization	0.291	0.037 - 2.258	0.237

Table 3. Multiple Logistic Regression Analysis

Odds ratio

95% CI

P Value

Hosmer-Lemeshow statistic: 3.175 (P = 0.923); Likelihood ratio test statistic: 28.474 (P ≤ 0.001)ICU: Intensive care unit; APACHE: Acute Physiology and Chronic Health Evaluation; LOS: Length of stay

APACHE II score

1.007

0.882 - 1.149

0.919

Hospital LOS

0.902

0.805 - 1.010

0.075

ICU LOS

1.119

0.988 - 1.267

0.076

Hospital LOS before ICU

0.965

0.819 - 1.138

0.675

ICU LOS prior to candidemia

0.714

0.531 - 0.960

0.026

Candida colonization

0.291

0.037 - 2.258

0.237