Predictive Utility of the Pediatric-EQUAL Scale in Pediatric Candidemia Admitted to PICU Association with Clinical and Microbiological Factors Related Mortality
Year: 2026
Type: article
Study design: Observational Study
Abstract: 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. 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. 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. 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. Candidemia is a serious infection in the blood caused by species. It is a big concern for very sick children in intensive care units (ICUs). Recognizing it quickly and giving the right antifungal treatment is important to help children survive. In this study, we looked at children with candidemia treated in the pediatric intensive care unit over 10 years. We used the Paed-EQUAL score, a tool for checking how well antifungal treatment is managed, to see if it can predict how well patients do. We studied 103 children. The results showed that children with higher Paed-EQUAL scores had a much better chance of surviving, especially those with scores of 16.5 or more. These findings suggest that the Paed-EQUAL score can be a useful tool to identify high-risk children with candidemia.
Source: Infectious Diseases and Therapy
Authors: Muhterem Duyu, Ayşe Aşık
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $7,400
OpenAlex ID: W7127359017