Candidemia as a cause of septic shock and multiple organ failure in nonimmunocompromised patients
Bibliographic record
Abstract
OBJECTIVE: To describe outcomes of septic shock and multiple organ failure arising from candidemia. DESIGN: Secondary cohort analysis of data from the placebo arm of the North American Septic Shock Trial (NORASEPT II), the largest prospective, randomized, double-blind, controlled multiple center study of septic shock conducted to date, with predetermined end point analysis of outcomes. SETTING: Adult intensive care units in 105 hospitals in the United States and Canada. SUBJECTS: A cohort of ten purely candidemic patients in septic shock were compared with a cohort of 376 purely bacteremic patients in septic shock. Patients were not immunocompromised, because patients on corticosteroids, with neutropenia, or posttransplantation were excluded from enrollment in NORASEPT II. MEASUREMENTS AND MAIN RESULTS: Demographic variables, baseline characteristics, 28-day mortality rates, and multiple organ failure were compared for the two cohorts. Candidemic patients were more likely to have a history of underlying renal failure at baseline and to require dialysis at onset of septic shock. Both causes of septic shock are associated with an extremely high severity of illness (Acute Physiology and Chronic Health Evaluation II: candidemic septic shock, 32 +/- 10; bacteremic septic shock, 30 +/- 8; p =.44). More than 70% of patients with candidemia and septic shock were in multiple organ failure at days 3, 7, and 14; patients with candidemic septic shock sustained persistent multiple organ failure and showed delayed recovery from multiple organ failure compared with patients with bacteremic septic shock. Mortality rate at 28 days was 60% in candidemic septic shock and 46% in bacteremic septic shock (p =.38). CONCLUSIONS: Candidemia with septic shock is infrequent in nonimmunocompromised patients but has a very high mortality rate, a high likelihood of associated multiple organ failure, and possibly a delayed recovery from multiple organ failure. Patients with candidemic septic shock are more likely to have underlying renal failure at baseline.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".