Background

The effects of early central venous catheter (CVC) removal on the clinical outcomes of patients with candidaemia remain controversial. We evaluated the impact of delayed CVC removal on mortality according to the severity of comorbidities in patients with candidaemia.

Methods

Patients with candidaemia in our tertiary care hospital between January 2010 and December 2017 were retrospectively included. The severity of comorbidities was classified as low [Charlson comorbidity index (CCI) score ≤3] and high (CCI score ≥4). Cases with removal of CVC > 2 days following onset of candidaemia or without CVC removal were classified as having delayed CVC removal.

Results

In total, 239 patients with candidaemia were included, excluding 18 who died within 2 days of candidaemia. Of these, 149 had low CCI scores and 90 had high CCI scores. Septic shock (aOR=9.5) and delayed CVC removal (aOR=4.7) were significantly associated with increased 30-day mortality, whereas Candida parapsilosis infection (aOR=0.2) and cerebrovascular disease (aOR=0.3) were associated with decreased 30-day mortality, in patients with low CCI scores. Septic shock (aOR=13.0) was the only risk factor for 30-day mortality in those with high CCI scores. Delayed CVC removal was associated with increased 30-day mortality in patients with low CCI scores (50.0% vs. 20.3%; P = 0.001), but not in those with high CCI scores (50.0% vs. 47.9%; P = 0.87).

Conclusion

Early CVC removal may improve the survival of patients with candidaemia and low CCI scores, but no such protective effect was evident in those with high CCI scores.

中文翻译：

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根据念珠菌血症患者合并症的严重程度延迟取出中心静脉导管的临床影响

背景

早期中央静脉导管（CVC）移除对念珠菌血症患者临床结局的影响仍然存在争议。我们根据念珠菌血症患者合并症的严重程度评估了延迟CVC清除对死亡率的影响。

方法

回顾性纳入2010年1月至2017年12月间我们三级医院的念珠菌血症患者。合并症的严重程度分为低[Charlson合并症指数（CCI）评分≤3]和高（CCI评分≥4）。念珠菌血症发作后2天内CVC去除或未去除CVC的病例归为CVC去除延迟。

结果

总共包括239名念珠菌血症患者，不包括18名在念珠菌血症两天内死亡的患者。其中，149 CCI得分低，90 CCI得分高。败血性休克（aOR = 9.5）和CVC清除延迟（aOR = 4.7）与30天死亡率增加显着相关，而副念珠菌感染（aOR = 0.2）和脑血管疾病（aOR = 0.3）与30天减少相关CCI评分低的患者的死亡率。在CCI得分高的人群中，败血症性休克（aOR = 13.0）是30天死亡率的唯一危险因素。CCI评分低的患者（50.0％vs. 20.3％; P = 0.001）与延迟CVC清除与30天死亡率增加相关，但CCI评分高的患者（30.0.0％vs. 47.9％; P = 0.87）与30天死亡率增加相关。

结论

尽早清除CVC可以改善念珠菌血症和低CCI评分患者的生存，但在高CCI评分患者中没有明显的保护作用。