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Introduction <p>Candidemia is a notable cause of morbidity and mortality in critically ill children. The Pediatric (Paed)-EQUAL scale, which includes 11 clinical and microbiological assessment parameters, was recently developed to improve guideline compliance in pediatric patients with candidemia. The aim of our study was to evaluate compliance with the Paed-EQUAL scale in pediatric patients with candidemia and to demonstrate its relationship with survival.</p> Methods <p>We retrospectively analyzed the clinical and microbiological characteristics and compliance with the Paed-EQUAL scale parameters of patients aged 1&#xa0;month to 18&#xa0;years who were diagnosed with candidemia and admitted to our pediatric intensive care unit over a 10-year period. Among the 117 candidemia cases identified, 103 were included in the study. We evaluated the associations between survival and various parameters, including the Paed-EQUAL score and candidemia-related clinical and microbiological characteristics.</p> Results <p>The 30-day mortality rate in our cohort was 17.5%. The Paed-EQUAL score had a significant discriminatory ability for identifying mortality outcomes. In the entire cohort, patients with a score of ≥ 16.5 had a greater likelihood of survival (AUC 0.742; <i>p</i> = 0.001). Separate analyses for patients with and without central venous catheters (CVCs) revealed that the discriminatory performance increased to an excellent level (AUC 0.913) among those without CVCs, which was based on a lower optimal cutoff (≥ 12.5). Multivariable regression revealed that the presence of breakthrough candidemia was associated with 10.5-fold greater odds of mortality (OR 10.52, 95%&#xa0;CI 1.66–66.7; <i>p</i> = 0.013), whereas each 1-point increase in the Paed-EQUAL score was associated with 1.4-fold greater odds of survival (OR 0.703, 95%&#xa0;CI 0.53–0.89; <i>p</i> = 0.004). Individual Paed-EQUAL components had no significant predictive role in assessing mortality risk.</p> Conclusion <p>The present study revealed that the Paed-EQUAL score can predict mortality in pediatric patients with candidemia. Patients with a Paed-EQUAL score of ≥ 16.5&#xa0;had significantly higher rates of survival.</p>

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Predictive Utility of the Pediatric-EQUAL Scale in Pediatric Candidemia Admitted to PICU Association with Clinical and Microbiological Factors Related Mortality

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月4日

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  • Muhterem Duyu,
  • Ayşe Aşık

摘要

Introduction

Candidemia is a notable cause of morbidity and mortality in critically ill children. The Pediatric (Paed)-EQUAL scale, which includes 11 clinical and microbiological assessment parameters, was recently developed to improve guideline compliance in pediatric patients with candidemia. The aim of our study was to evaluate compliance with the Paed-EQUAL scale in pediatric patients with candidemia and to demonstrate its relationship with survival.

Methods

We retrospectively analyzed the clinical and microbiological characteristics and compliance with the Paed-EQUAL scale parameters of patients aged 1 month to 18 years who were diagnosed with candidemia and admitted to our pediatric intensive care unit over a 10-year period. Among the 117 candidemia cases identified, 103 were included in the study. We evaluated the associations between survival and various parameters, including the Paed-EQUAL score and candidemia-related clinical and microbiological characteristics.

Results

The 30-day mortality rate in our cohort was 17.5%. The Paed-EQUAL score had a significant discriminatory ability for identifying mortality outcomes. In the entire cohort, patients with a score of ≥ 16.5 had a greater likelihood of survival (AUC 0.742; p = 0.001). Separate analyses for patients with and without central venous catheters (CVCs) revealed that the discriminatory performance increased to an excellent level (AUC 0.913) among those without CVCs, which was based on a lower optimal cutoff (≥ 12.5). Multivariable regression revealed that the presence of breakthrough candidemia was associated with 10.5-fold greater odds of mortality (OR 10.52, 95% CI 1.66–66.7; p = 0.013), whereas each 1-point increase in the Paed-EQUAL score was associated with 1.4-fold greater odds of survival (OR 0.703, 95% CI 0.53–0.89; p = 0.004). Individual Paed-EQUAL components had no significant predictive role in assessing mortality risk.

Conclusion

The present study revealed that the Paed-EQUAL score can predict mortality in pediatric patients with candidemia. Patients with a Paed-EQUAL score of ≥ 16.5 had significantly higher rates of survival.