[1]徐媛媛,叶林,钮柏琳.修正性MDRA评分对ICU侵袭性真菌感染患者的预测价值[J].第三军医大学学报,2019,41(10):980-986.
 XU Yuanyuan,YE Lin,NIU Bailin.Predictive value of a modified Multi-disease Risk Assessment cutoff score for invasive fungal infection in ICU[J].J Third Mil Med Univ,2019,41(10):980-986.
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修正性MDRA评分对ICU侵袭性真菌感染患者的预测价值(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第10期
页码:
980-986
栏目:
临床医学
出版日期:
2019-05-30

文章信息/Info

Title:
Predictive value of a modified Multi-disease Risk Assessment cutoff score for invasive fungal infection in ICU
作者:
徐媛媛叶林钮柏琳
重庆医科大学附属第一医院,急诊&重症医学科
Author(s):
XU Yuanyuan YE Lin NIU Bailin

Department of Emergency and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

关键词:
ICU侵袭性真菌感染修正性MDRA评分效能分析
Keywords:
intensive care unit invasive fungal infection Multi-disease Risk Assessment efficacy analysis  
分类号:
R459.7;R519;R631
文献标志码:
A
摘要:

目的 分析修正性MDRA评分对ICU内患者侵袭性真菌感染(invasive fungal infection,IFI)的预测价值。方法 回顾性收集2016年7月至2018年6月本院ICU住院的具有侵袭性真菌感染高危因素患者的病例资料,分析原有MDRA评分系统对ICU侵袭性真菌感染的预测效能,并比较评价修正性MDRA评分在其临床干预时机选择中的效能。结果 按原有MDRA≥30分标准筛选393例具有IFI高危因素的患者中MDRA≥30分有276人,后续确诊或临床诊断为IFI的患者有101人。通过统计分析,修正后以MDRA=36分为cut off值,诊断IFI的灵敏度为85.61%,特异度为89.38%,诊断效能较好。当MDRA≥36分,与未及时启动抗真菌治疗方案的患者(B0组 76例)比较,24 h内启动抗真菌治疗方案的患者(A0组 37例)病死率明显下降(P<0.05),且呼吸机使用时间及ICU住院时间明显缩短(P<0.05)。 结论 修正的MDRA评分(MDRA≥36分)对ICU内IFI感染有较高的预测价值。

Abstract:

Objective To analyze the predictive value of a modified cutoff score of Multi-disease Risk Assessment (MDRA) for invasive fungal infection in patients admitted in the intensive care unit (ICU) and explore the optimal time window for intervention. Methods We retrospectively collected the clinical data of patients at high risk of invasive fungal infection, who were admitted in the ICU in our department between July, 2016 and June, 2018. We compared the predictive value of the original and the modified MDRA cutoff scores for invasive fungal infection in these patients. Results We screened a total of 393 high-risk patients, among whom 276 had MDRA scores above 30; 101 of the patients had a subsequent diagnosis or a clinical diagnosis of invasive fungal infections. After statistical analysis, we used a MDRA score of 36 as the cut-off value, which showed a sensitivity of 85.61% and a specificity of 89.38% for predicting invasive fungal infection. Among the patients with a MDRA score ≥36, the patients who received antifungal therapy within 24 h (37 cases, Group A0) had a significantly reduced mortality (P<0.05) with also shortened duration of ventilator use and ICU stay (P<0.05) as compared with the 76 patients (Group B0) who did not receive antifungal therapy in time. Conclus ionIn patients admitted in ICU, a MDRA score ≥36 has a high predictive value for invasive fungal infection and is indicative of immediate interventions with antifungal drugs.

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更新日期/Last Update: 2019-05-24