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Background <p>Candidemia displays significant clinical heterogeneity in critically ill patients. This study aimed to identify distinct clinical phenotypes and to assess their association with 90-day mortality.</p> Methods <p>We conducted a multicenter retrospective cohort study of 492 intensive care unit (ICU) patients with candidemia from 16 French ICUs (2015–2023). We performed a factor analysis of mixed data (FAMD) incorporating both categorical and continuous baseline variables, followed by hierarchical clustering on principal components (HCPC). Survival analysis was performed with Kaplan–Meier curves and Cox proportional hazards models.</p> Results <p>Overall, 90-day mortality for the 492 patients (median age: 64&#xa0;years, 69.1% male) with candidemia was 62.6%. Three different phenotypes emerged from FAMD followed by HCPC: Phenotype 1 (<i>n</i> = 70, 14.2%) comprised patients with severe immunosuppression, mostly due to hematological malignancies (82.9%), and high severity scores (SAPS II:70); Phenotype 2 (<i>n</i> = 223, 45.3%) corresponded to elderly cirrhotic patients (19.3%) with early-onset digestive candidemia; Phenotype 3 (<i>n</i> = 199, 40.5%) comprised younger patients with lower severity scores and catheter-related candidemia. Mortality differed significantly between phenotypes: 72.9% (Phenotype 1), 70.4% (Phenotype 2), and 50.3% (Phenotype 3) (<i>p</i> &lt; 0.001). Independent predictors of mortality included age (aHR: 1.01, 95% CI: 1.00-1.02; <i>p</i> = 0.003), cirrhosis (aHR: 1.90, 95% CI: 1.39-2.60; <i>p</i> &lt; 0.001), SAPS II (aHR: 1.01, 95% CI: 1.01-1.02; <i>p</i> &lt; 0.001), echinocandin use (aHR = 0.49, 95% CI: 0.39-0.63; p &lt; 0.001) and proven catheter-related candidemia (protective; aHR: 0.48, 95% CI: 0.33-0.69; <i>p</i> &lt; 0.001). Immunodepression was not associated with mortality.</p> Conclusion <p>Unsupervised clustering identified three clinically different candidemia phenotypes with different outcomes. Cirrhosis, higher age and illness severity were associated with mortality, whereas a catheter-related source of infection was protective.</p>

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Decoding candidemia in critically ill patients: unsupervised clustering identifies three unique phenotypes

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  • 发表日期：

    2026年6月28日

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  • Florian Reizine,
  • Juliette Henry,
  • Luc Desmedt,
  • Christophe Camus,
  • Valentin Coirier,
  • François Arrive,
  • Estelle Burban,
  • Gabriel Eustache,
  • Tony Belleville,
  • Antoine Marc,
  • Jolan Malherbe,
  • Pierre Bouju,
  • Paul Jaubert,
  • Olivier Lesieur,
  • Maxime Leclerc,
  • Pierre Fillâtre,
  • Aurélien Frérou,
  • Renaud Prével,
  • Nolwenn Mainguy,
  • Anne Cady,
  • Florent Morio,
  • Solène Le Gal,
  • Estelle Perraud,
  • Laurence Delhaes,
  • Sébastien Imbert,
  • Helene Guegan,
  • Julie Bonhomme,
  • Marc Pihet,
  • Clarisse Dupin,
  • Agathe Delbove,
  • Damien Du Cheyron,
  • Yoann Launey,
  • Cécile Aubron,
  • Jean-Pierre Gangneux

摘要

Background

Candidemia displays significant clinical heterogeneity in critically ill patients. This study aimed to identify distinct clinical phenotypes and to assess their association with 90-day mortality.

Methods

We conducted a multicenter retrospective cohort study of 492 intensive care unit (ICU) patients with candidemia from 16 French ICUs (2015–2023). We performed a factor analysis of mixed data (FAMD) incorporating both categorical and continuous baseline variables, followed by hierarchical clustering on principal components (HCPC). Survival analysis was performed with Kaplan–Meier curves and Cox proportional hazards models.

Results

Overall, 90-day mortality for the 492 patients (median age: 64 years, 69.1% male) with candidemia was 62.6%. Three different phenotypes emerged from FAMD followed by HCPC: Phenotype 1 (n = 70, 14.2%) comprised patients with severe immunosuppression, mostly due to hematological malignancies (82.9%), and high severity scores (SAPS II:70); Phenotype 2 (n = 223, 45.3%) corresponded to elderly cirrhotic patients (19.3%) with early-onset digestive candidemia; Phenotype 3 (n = 199, 40.5%) comprised younger patients with lower severity scores and catheter-related candidemia. Mortality differed significantly between phenotypes: 72.9% (Phenotype 1), 70.4% (Phenotype 2), and 50.3% (Phenotype 3) (p < 0.001). Independent predictors of mortality included age (aHR: 1.01, 95% CI: 1.00-1.02; p = 0.003), cirrhosis (aHR: 1.90, 95% CI: 1.39-2.60; p < 0.001), SAPS II (aHR: 1.01, 95% CI: 1.01-1.02; p < 0.001), echinocandin use (aHR = 0.49, 95% CI: 0.39-0.63; p < 0.001) and proven catheter-related candidemia (protective; aHR: 0.48, 95% CI: 0.33-0.69; p < 0.001). Immunodepression was not associated with mortality.

Conclusion

Unsupervised clustering identified three clinically different candidemia phenotypes with different outcomes. Cirrhosis, higher age and illness severity were associated with mortality, whereas a catheter-related source of infection was protective.