Prognostic Impact of Nutritional Status in Patients with Candidemia
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Patient Enrollment
2.2. Patient Characteristics and Disease Severity
2.3. Data Collection
2.4. Microbiological Evaluation
2.5. Statistical Analyses
3. Results
3.1. Receiver Operating Characteristic (ROC) Curves of CONUT Score for 30-Day
3.2. Prognostic Accuracy of CONUT Score for 30-Day Mortality
3.3. Comparison of Overall Survival Time Between CONUT Score ≥12 and <12
3.4. Univariate and Multivariate Analyses of 30-Day Mortality Among Candidemia Patients
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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| Variables | All Patients | Survival Group | 30-Day Death Group (n = 61) | p-Value |
|---|---|---|---|---|
| (n = 170) | (n = 109) | |||
| Mean age (years ± SD) | 73.0 ± 13.7 | 72.6 ± 13.7 | 73.7 ± 13.7 | 0.625 |
| Median age (years, range) | 76 (18–95) | 75 (18–94) | 77 (20–95) | - |
| Gender (n,%) | ||||
| Male | 108 (64) | 70 (64) | 38 (62) | 0.802 |
| Female | 62 (36) | 39 (36) | 23 (38) | |
| Nutritional status | ||||
| Body mass index (kg/m2) (mean ± SD) | 19.2 ± 3.9 | 19.1 ± 4.1 | 19.4 ± 3.6 | 0.661 |
| CONUT score | 9.5 ± 2.1 | 8.9 ± 2.2 | 10.5 ± 1.6 | <0.001 |
| Prognostic Nutritional Index | 26.5 ± 6.8 | 28.4 ± 7.0 | 23.1 ± 4.8 | <0.001 |
| Geriatric Nutritional Risk Index | 70.0 ± 10.5 | 71.7 ± 11.0 | 66.4 ± 8.6 | 0.001 |
| GLIM criteria (n,%) | ||||
| Moderate malnutrition | 123 (72) | 77 (71) | 46 (75) | 0.505 |
| Severe malnutrition | 100 (59) | 63 (58) | 37 (61) | 0.717 |
| Risk factors of candidemia (n,%) | ||||
| Prior antibiotics | 148 (87) | 93 (85) | 55 (90) | 0.367 |
| Surgical procedure | 36 (21) | 26 (24) | 10 (16) | 0.253 |
| Immunosuppressive agents | 34 (20) | 17 (16) | 17 (28) | 0.055 |
| Tube feeding | 39 (23) | 27 (25) | 12 (20) | 0.448 |
| Total parenteral nutrition | 88 (52) | 51 (47) | 37 (61) | 0.083 |
| Chemotherapy | 36 (21) | 20 (18) | 16 (26) | 0.228 |
| ICU admission | 51 (30) | 34 (31) | 17 (28) | 0.65 |
| CVC insertion | 117 (69) | |||
| Source of infections (n,%) | ||||
| CRBSI | 91 (53) | 64 (59) | 27 (44) | 0.07 |
| Unknown | 71 (42) | 37 (34) | 34 (56) | 0.006 |
| Others | 8 (5) | 8 (7) | 0 | 0.03 |
| Severity of candidemia (Mean ± SD) | ||||
| Quick SOFA score | 1.3 ± 1.0 | 0.2 ± 0.4 | 0.6 ± 0.5 | <0.001 |
| SOFA score | 4.7 ± 3.3 | 2.5 ± 2.6 | 5.8 ± 3.5 | 0.009 |
| SIRS score | 2.1 ± 1.1 | 1.9 ± 1.2 | 2.2 ± 1.0 | 0.071 |
| Condition (n,%) | ||||
| Septic shock | 41 (24) | 22 (20) | 19 (31) | 0.135 |
| Disseminated intravascular coagulation | 49 (29) | 26 (24) | 23 (33) | 0.083 |
| Underlying diseases (n,%) | ||||
| Heart disease | 46 (27) | 27 (25) | 19 (31) | 0.369 |
| Chronic pulmonary disease | 16 (9) | 10 (9) | 6 (10) | 0.887 |
| Hepatic disease | 7 (4) | 5 (4.6) | 2 (3) | 0.68 |
| Diabetes mellitus | 50 (29) | 35 (32) | 15 (25) | 0.302 |
| Chronic kidney disease | 23 (14) | 13 (12) | 10 (16) | 0.414 |
| Hemodialysis | 11 (6) | 5 (4.6) | 6 (10) | 0.182 |
| Gastrointestinal disease | 4 (14) | 3 (2.8) | 1 (1.6) | 0.646 |
| Collagen vascular disease | 14 (2.4) | 8 (7) | 6 (10) | 0.57 |
| Cerebrovascular disease | 40 (24) | 27 (25) | 13 (21) | 0.65 |
| Malignancy | 90 (53) | 56 (51) | 34 (56) | 0.585 |
| Metastasis | 47 (28) | 28 (26) | 19 (31) | 0.445 |
| Paralysis | 7 (4) | 5 (5) | 2 (3) | 0.706 |
| Charlson comorbidity index (mean ± SD) | 3.7 ± 2.5 | 3.5 ± 2.6 | 4.1 ± 2.4 | 0.124 |
| Charlson comorbidity index ≥ 3 (n,%) | 99 (58) | 58 (53) | 41 (67) | 0.066 |
| Initial antifungal therapy (n,%) | ||||
| Echinocandin | 118 (69) | 82 (48) | 36 (59) | 0.028 |
| Azole | 17 (10) | 12 (11) | 5 (8) | 0.545 |
| Polyene antimycotic | 22 (13) | 15 (14) | 7 (11) | 0.877 |
| None | 13 (8) | 0 | 13 (21) | <0.001 |
| EQUAR Candida score (mean ± SD) | ||||
| All cases (n = 170) | 12.4 ± 2.8 | 14.2 ± 2.4 | 11.2 ± 2.9 | <0.001 |
| With CVC (n = 117) | 13.7 ± 3.0 | 14.9 ± 2.6 | 11.8 ± 3.1 | <0.001 |
| Without CVC (n = 53) | 11.5 ± 2.2 | 12.5 ± 1.9 | 9.6 ± 1.5 | <0.001 |
| Duration of | ||||
| hospital stay (mean days ± SD) | 68.9 ± 58.6 | 75.8 ± 63.6 | 56.4 ± 46.4 | 0.024 |
| antifungal treatment (mean days ± SD) | 29.5 ± 69.3 | 40.0 ± 84.6 | 10.9 ± 9.4 | 0.001 |
| Outcome | ||||
| Mortality (n,%) | ||||
| 30-day mortality | 61 (35) | - | - | - |
| In-hospital mortality | 75 (44) | - | ||
| Pathogen isolated by blood culture (n,%) | ||||
| Candida albicans | 78 (46) | 45 (41) | 33 (54) | 0.108 |
| Candida parapsilosis | 43 (25) | 31 (28) | 12 (20) | 0.207 |
| Candida glabrata | 35 (21) | 24 (22) | 11 (18) | 0.538 |
| Candida tropicalis | 9 (5) | 6 (5.5) | 3 (5) | 0.87 |
| Candida guilliermondii | 8 (4.7) | 7 (6) | 1 (1.6) | 0.158 |
| Candida krusei | 1 (0.6) | 0 | 1 (1.6) | 0.18 |
| Others | 1 (0.6) | 1 (0.9) | 0 | 0.453 |
| CONUT Score | Sensitivity (%) | Specificity (%) | PPV (%) | NPV (%) | Youden Index |
|---|---|---|---|---|---|
| ≥8 | 40 | 91 | 97 | 89 | 31 |
| ≥10 | 50 | 71 | 71 | 61 | 21 |
| ≥12 | 72 | 73 | 38 | 92 | 44 |
| Variables | HR | 95% CI | p-Value | HR | 95% CI | p-Value |
|---|---|---|---|---|---|---|
| CONUT score (≥12) | 6.7 | 2.9–15.8 | <0.001 | 2.1 | 1.1–4.0 | 0.025 |
| SOFA score (≥5) | 7.1 | 3.2–15.7 | <0.001 | 2.6 | 1.4–4.8 | 0.002 |
| CCI (≥3) | 1.8 | 1.0–3.6 † | 0.055 | - | - | - |
| EQUAL Candida score (≥10) | 0.0 * | 0.0–0.1 | <0.001 | 0.1 ** | 0.0–0.1 *** | <0.001 |
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Asai, N.; Ohashi, W.; Shibata, Y.; Sakanashi, D.; Kato, H.; Hagihara, M.; Mikamo, H. Prognostic Impact of Nutritional Status in Patients with Candidemia. Nutrients 2026, 18, 936. https://doi.org/10.3390/nu18060936
Asai N, Ohashi W, Shibata Y, Sakanashi D, Kato H, Hagihara M, Mikamo H. Prognostic Impact of Nutritional Status in Patients with Candidemia. Nutrients. 2026; 18(6):936. https://doi.org/10.3390/nu18060936
Chicago/Turabian StyleAsai, Nobuhiro, Wataru Ohashi, Yuichi Shibata, Daisuke Sakanashi, Hideo Kato, Mao Hagihara, and Hiroshige Mikamo. 2026. "Prognostic Impact of Nutritional Status in Patients with Candidemia" Nutrients 18, no. 6: 936. https://doi.org/10.3390/nu18060936
APA StyleAsai, N., Ohashi, W., Shibata, Y., Sakanashi, D., Kato, H., Hagihara, M., & Mikamo, H. (2026). Prognostic Impact of Nutritional Status in Patients with Candidemia. Nutrients, 18(6), 936. https://doi.org/10.3390/nu18060936

