Mortality Risk Factors in Invasive Candidiasis: A Retrospective Cohort Study

Background Invasive candidiasis (IC) is a critical infection disease with high mortality caused by Candida spp. , accurate clinical diagnosis for significant treatment and infection control challenges in critical care settings‌. Method This study evaluated IC inpatients diagnosed through mycological evidence over 12 months, Inclusion criteria required at least one positive mycological result including blood, cerebrospinal fluid, pleural and ascitic fluid, joint fluid, and pus. Results A total of 223 inpatients with IC, with a mortality rate was 46.2%, bloodstream infections (BSIs) were the most severe disease with mortality at 70.3%. Among 88 cases of BSIs, 77.3% were aerobic bottles with a culture mean time was 39.1 ± 26.7h(3 ~ 140h). Abdominal infection was the main source of infection at 46.6%, followed by catheter-related sources at 18.8%. Biomarkers for IC diagnosis value, with area under the curve (AUC) values for PCT was 0.827, when PCT ≥ 0.778 ug/ml, the sensitivity and specificity of 0.667 and 0.862,respectively.The IC 28-day survival rate was 0.640 ± 0.038 overall, compared to 0.499 ± 0.061 for BSIs patients. Multivariable regression analysis identified several significant factors associated with in-hospital mortality: PCT ≥ 0.778 ng/mL (OR 3.800, 95% CI1.995-7.237, p < 0.001), IL-6 ≥ 25.375 pg/mL (OR 3.667,95% CI, 1.372–9.795, p = 0.01), the BSIs (OR 4.431,95% CI 2.438–8.054, p < 0.001), and ICU admission (OR:2.351,95% CI, 1.269–4.356 p < 0.007). Conclusion IC is a serious infectious disease with high mortality and source mainly from abdominal infection, key risk factors for mortality include BSIs, ICU admission elevated PCT and IL-6.