Aim: This study sought to evaluate the effectiveness of lactate/albumin ratio for ICU mortality prediction in a large cohort of patients with severe Coronavirus Disease-2019 (COVID-19) admitted to an intensive care unit (ICU). Methods: This is a single-center retrospective cohort study of prospectively collected data derived from the COVID-19 dataset for all critically ill patients admitted to an academic ICU. Data were used to determine the relation between lactate/albumin ratio and other laboratory parameters measured on the first day of the ICU stay and to evaluate the prognostic performance for ICU mortality prediction. Results: A total of 805 ICU patients were included, and the median age (IQR) was 67 (57–76) years, with 68% being male. ICU mortality was 48%, and the median lactate/albumin ratio was 0.53 (0.39–0.59). A survival analysis showed that patients with higher lactate/albumin ratio values had significantly lower survival rates (Log Rank p < 0.001). A multivariable analysis revealed that the lactate/albumin ratio was an independent risk factor for ICU mortality with a hazard ratio of 1.39 (CI: 1.27–1.52). The lactate/albumin ratio showed a receiver operating characteristics area under the curve (ROC-AUC) value to predict ICU mortality significantly higher than that of lactate alone (0.71 vs. 0.68, DeLong test p < 0.001). The optimal lactate/albumin ratio cut-off for predicting ICU mortality was 0.57, with 63% sensitivity and 73% specificity. A subgroup analysis revealed that the lactate/albumin ratio was significantly associated with mortality across different patient groups, including age and sex categories, and those with or without hypertension and coronary heart disease. Conclusions: Lactate/albumin ratio is a reliable prognostic marker in critically ill COVID-19 patients and could predict ICU mortality more accurately than lactate alone.

Background: The aim of this study was to investigate the usefulness of serum procalcitonin (PCT), C-reactive protein (CRP), neutrophil to lymphocyte count ratio (NLR), and their combination, in distinguishing candidemia from bacteremia in intensive care unit (ICU) patients. Methods: This is a retrospective study in ICU patients with documented bloodstream infections (BSIs) and with both serum PCT and CRP measurements on the day of the positive blood sample. Illness severity was assessed by sequential organ failure assessment (SOFA) score on both admission and BSI day. Demographic, clinical, and laboratory data, including PCT and CRP levels and NLR on the day of the BSI, were recorded. Results: A total of 63 patients were included in the analysis, of whom 32 had bacteremia and 31 had candidemia. PCT, CRP, and NLR values were all significantly lower in candidemia compared with bacteremia (0.29 (0.14–0.69) vs. 1.73 (0.5–6.9) ng/mL, p < 0.001, 6.3 (2.4–11.8) vs. 19 (10.7–24.8) mg/dl, p < 0.001 and 6 (3.7–8.6) vs. 9.8 (5.3–16.3), p = 0.001, respectively). PCT was an independent risk factor for candidemia diagnosis (OR 0.153, 95%CI: 0.04–0.58, p = 0.006). A multivariable model consisting of the above three variables had better predictive ability (AUC-ROC = 0.88, p < 0.001), for candidemia diagnosis, as compared to that of PCT, CRP, and NLR, whose AUC-ROCs were all lower (0.81, p < 0.001, 0.78, p < 0.001, and 0.68, p = 0.015, respectively). Conclusions: A combination of routinely available laboratory tests, such as PCT, CRP, and NLR, could prove useful for the early identification of ICU patients with candidemia.

Background: Candidozyma auris (C. auris) is an emerging multidrug-resistant yeast that has become an important cause of healthcare-associated outbreaks, particularly in intensive care units (ICUs). Colonization frequently precedes invasive infection, yet the epidemiology, progression to candidemia, and mortality among critically ill patients remain incompletely characterized. Methods: We conducted a narrative review of published studies evaluating C. auris colonization and infection in ICU populations. Studies reporting colonization rates, progression to invasive infection, and mortality were synthesized. Descriptive pooled proportions were calculated from aggregated data across eligible observational studies. Results: Colonization rates varied widely according to local epidemiology, ranging from 0.2 to 0.4% in routine surveillance studies to over 50% during outbreaks. Across 17 observational studies including 1879 colonized ICU patients, 616 developed invasive infection, yielding a descriptive pooled incidence of 32.8% (95% CI, 30.7–34.9%), predominantly candidemia. The median interval from ICU admission to candidemia was 25.8 days. Among 13 studies including 1354 colonized and/or infected ICU patients, the descriptive pooled 30-day in-hospital mortality was 36.4% (95% CI, 33.8–39.0%). In 12 studies comprising 396 patients with C. auris candidemia, the descriptive pooled 30-day mortality was 45.9% (95% CI, 41.0–50.8%), significantly higher than that observed in mixed colonized/infected ICU populations. Conclusions: C. auris represents a major threat in ICUs because of its ability to establish persistent colonization, progress to invasive candidemia, and cause high mortality among critically ill patients. Early identification of colonized patients, rigorous infection prevention measures, and prompt antifungal management are essential to reduce transmission and improve clinical outcomes.

Aim: This study sought to evaluate the effectiveness of lactate/albumin ratio for ICU mortality prediction in a large cohort of patients with severe Coronavirus Disease-2019 (COVID-19) admitted to the intensive care unit (ICU). Methods: This is a single-center retrospective cohort study of prospectively collected data derived from the COVID-19 dataset for all critically ill patients admitted to an academic ICU. Data were used to determine the relation between lactate/albumin ratio and other laboratory parameters measured on the first day of ICU stay and to evaluate the prognostic performance for ICU mortality prediction. Results: A total of 805 ICU patients were included, the median age (IQR) was 67 (57-76) years, with 68% being male. ICU mortality was 48% and the median lactate/albumin ratio was 0.53 (0.39-0.59). Survival analysis showed that patients with higher lactate/albumin ratio values had significantly lower survival rates (Log Rank p<0.001). A multivariable analysis revealed that the lactate/albumin ratio was an independent risk factor for ICU mortality with a hazard ratio of 1.39 (CI: 1.27-1.52). Lactate/albumin ratio showed a receiver-operating characteristics area under the curve (ROC-AUC) value to predict ICU mortality significantly higher than that of lactate alone (0.71 vs 0.68, DeLong test p<0.001). The optimal lactate/albumin ratio cut-off for predicting ICU mortality was 0.57, with 63% sensitivity and 73% specificity. Subgroup analysis revealed that lactate/albumin ratio was significantly associated with mortality across different patient groups, including age and sex categories, and those with or without hypertension and coronary heart disease. Conclusion: Lactate/albumin ratio is a reliable prognostic marker in critically ill COVID-19 patients and could predict ICU mortality more accurately than lactate alone.

Background: Candidozyma auris (C. auris) is an emerging multidrug-resistant yeast that has become an important cause of healthcare-associated outbreaks, particularly in intensive care units (ICUs). Colonization frequently precedes invasive infection, yet the epidemiology, progression to candidemia, and mortality among critically ill patients remain incompletely characterized. Methods: We conducted a narrative review of published studies evaluating C. auris colonization and infection in ICU populations. Studies reporting colonization rates, progression to invasive infection, and mortality were synthesized. Pooled estimates were calculated using aggregated data from eligible observational studies. Results: Colonization rates varied widely according to local epidemiology, ranging from 0.2–0.4% in routine surveillance studies to over 50% during outbreaks. Across 17 observational studies including 1,879 colonized ICU patients, 616 developed invasive infection, yielding a pooled incidence of 32.8%, predominantly candidemia. The median interval from ICU admission to candidemia was 25.8 days. Among 13 studies including 1,354 colonized and/or infected ICU patients, the pooled 30-day in-hospital mortality was 36.4% (95% CI, 33.8–39.0%). In 12 studies comprising 396 patients with C. auris candidemia, pooled 30-day mortality was 45.9% (95% CI, 41.0–50.8%), significantly exceeding that in mixed colonized/infected populations. Conclusions: Candidozyma auris represents a major threat in ICUs because of its ability to establish persistent colonization, progress to invasive candidemia, and cause high mortality among critically ill patients. Early identification of colonized patients, rigorous infection prevention measures, and prompt antifungal management are essential to reduce transmission and improve clinical outcomes.