Attributable Mortality to Candidiasis in Non-Neutropenic Critically Ill Patients in the ICU and a Post-Mortem Study

Candidiasis remains one of the most challenging infections to treat in critical care, due to its diagnostic difficulties and uncertainty regarding whether it can be directly related to the death of patients with multiorgan failure. This study aims to verify that the statistically attributable mortality in this infection is as consistent as the post-mortem attributable mortality. A prospective study was conducted in non-neutropenic ICU patients in whom Candida was detected. Invasive candidiasis is defined based on evidence of disseminated or multifocal candidiasis. Post-mortem study is used as the gold standard for Candida-attributable mortality, and is compared with attributable mortality determined according to clinical study and statistically attributable mortality in relation to the overall mortality of ICU patients and colonized patients. The post-mortem attributable mortality was 30.6% and 22.6% according to the clinical study, while the statistically attributable mortality was 25% in relation to overall ICU mortality and 27% in relation to Candida colonization. Thus, the results of the different calculations of attributable mortality (statistical vs. crude death rate) due to Candida are in agreement. The use of this metric may help to improve ICU outcomes for non-neutropenic critically ill patients with candidiasis.