关键词: 念珠菌血症, 肿瘤, 凝血功能障碍, （1, 3）-β-D-葡聚糖, 预后, 危险因素

Abstract:

Objective To analyze the etiological characteristics and prognosis risk factors of pathogenic bacteria in tumor patients with candidemia，so as to provide a reference for improving the prognosis of patients. Methods All the patients with candidemia in Fudan University Cancer Hospital from January 2013 to December 2022 were enrolled and classified into death group and survival group according to their prognosis. The differences of disease spectrum，microbiological data of clinical isolates and laboratory determination results were compared between death group and survival group. Logistic regression analysis was used to evaluate the risk factors of death in tumor patients with candidemia. Receiver operating characteristics （ROC） curves were used to assess the effectiveness of risk factors in determining patient prognosis. Results A total of 67 tumor patients with candidemia were enrolled，mainly pancreatic cancer （25.4%），colorectal cancer （16.4%） and esophageal cancer （16.4%）. Totally，26 cases （38.8%） died. Totally，68 isolates of Candida were isolated，mainly Candida albicans （44.1%），Candida parapsilosis（20.6%）and Candida glabrata（11.8%）. The 98.4% of Candida isolates were amphotericin B wild type， and 90.9% were itraconazole wild type. Distant metastasis of primary tumor，three or more underlying diseases，hemodialysis，tracheotomy，mechanical ventilation，bacterial bloodstream infection and central venous catheter-related fungal infection were the prognostic factors （P<0.05）. Distant metastasis of primary tumor （P=0.003） and mechanical ventilation （P=0.019） were independent risk factors for death. Totally，43 patients were determined for（1，3） -beta-D-glucan （BDG），with a positive rate of 48.8%. There was statistical significance in serum C-reactive protein （CRP），procalcitonin （PCT），platelet（PLT） count ，plasma fibrinogen （Fib），D-dimer （DD） and fibrinogen degradation product （FDP） between death and survival groups （P<0.05）. The area under curve of PLT count for predicting death of tumor patients with candidemia was 0.751，which was higher than other indexes. DD （88.0%）was more sensitive to predict death in tumor patients with candidemia than other indexes，and PCT （77.3%）was more specific to predict death in tumor patients with candidemia than other indexes. Conclusions he prognosis of tumor patients with candidemia is poor，and the pathogenic bacteria are Candida albicans，mainly amphotericin B wild type isolates. Distant metastasis of primary tumor and mechanical ventilation are related to patient death. The combination of BDG and blood culture is helpful for early diagnosis. Serum CRP，PCT，PLT count，Fib，DD and FDP levels can predict the prognosis of patients to a certain extent. PCT and DD can be used to predict patient survival.

Key words: Candidemia, Tumor, Coagulation dysfunction, （1, 3）-Beta-D-glucan, Prognosis, Risk factor