Background Almost one third of the patients with candidemia develop septic shock. The understanding why some patients do and others do not develop septic shock is very limited. The objective of this study was to identify variables associated with septic shock development in a large population of patients with candidemia. Methods A post hoc analysis was performed on two prospective, multicenter cohort of patients with candidemia from 12 hospitals in Spain and Italy. All episodes occurring from September 2016 to February 2018 were analyzed to assess variables associated with septic shock development defined according to The Third International Consensus Definition for Sepsis and Septic Shock (Sepsis-3). Results Of 317 candidemic patients, 99 (31.2%) presented septic shock attributable to candidemia. Multivariate logistic regression analysis identifies the following factors associated with septic shock development: age > 50 years (OR 2.57, 95% CI 1.03–6.41, p = 0.04), abdominal source of the infection (OR 2.18, 95% CI 1.04–4.55, p = 0.04), and admission to a general ward at the time of candidemia onset (OR 0.21, 95% CI, 0.12–0.44, p = 0.001). Septic shock development was independently associated with a greater risk of 30-day mortality (OR 2.14, 95% CI 1.08–4.24, p = 0.02). Conclusions Age and abdominal source of the infection are the most important factors significantly associated with the development of septic shock in patients with candidemia. Our findings suggest that host factors and source of the infection may be more important for development of septic shock than intrinsic virulence factors of organisms.

中文翻译：

---

念珠菌血症患者发生感染性休克的相关因素：来自两个前瞻性队列的事后分析

背景 几乎三分之一的念珠菌血症患者会发生感染性休克。为什么有些患者会发生而其他患者不会发生感染性休克的理解非常有限。本研究的目的是确定与大量念珠菌血症患者发生感染性休克相关的变量。方法 对来自西班牙和意大利 12 家医院的两个前瞻性、多中心的念珠菌血症患者队列进行了事后分析。对 2016 年 9 月至 2018 年 2 月发生的所有事件进行了分析，以评估与根据脓毒症和脓毒性休克第三国际共识定义 (Sepsis-3) 定义的脓毒性休克发展相关的变量。结果 317 例念珠菌血症患者中，99 例（31.2%）因念珠菌血症出现感染性休克。多变量逻辑回归分析确定了以下与感染性休克发展相关的因素：年龄 > 50 岁（OR 2.57，95% CI 1.03-6.41，p = 0.04），腹部感染源（OR 2.18，95% CI 1.04-4.55， p = 0.04），并在念珠菌血症发作时入住普通病房（OR 0.21，95% CI，0.12–0.44，p = 0.001）。感染性休克的发展与更大的 30 天死亡率风险独立相关（OR 2.14，95% CI 1.08–4.24，p = 0.02）。结论年龄和腹部感染源是念珠菌血症患者发生感染性休克的最重要因素。我们的研究结果表明，宿主因素和感染源对于感染性休克的发展可能比生物体的内在毒力因素更重要。