Bloodstream Invasion Dominates Mortality in Invasive Candidiasis: Single-center Insights on Abdominal Origins, Antifungal Efficacy, and Biomarker-Driven Prognosis

Bloodstream Invasion Dominates Mortality in Invasive Candidiasis: Single-center Insights on Abdominal Origins, Antifungal Efficacy, and Biomarker-Driven Prognosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Bloodstream Invasion Dominates Mortality in Invasive Candidiasis: Single-center Insights on Abdominal Origins, Antifungal Efficacy, and Biomarker-Driven Prognosis Qiangsheng Feng, Xiaoqin Ha, Yuejuan Song This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7822150/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Invasive candidiasis (IC), particularly candidemia (56.7% mortality), faces diagnostic delays with blood cultures. Early identification of infection sources and biomarkers (PCT, IL-6, β-D-glucan) could enable prompt intervention. Methods A 12-month retrospective cohort study analyzed 223 hospitalized IC patients (2013–2024; incidence 31.9/100,000 patient-years) confirmed by sterile-site mycological evidence. Biomarkers, microbiology (BD/Vitek, CLSI susceptibility), and mortality predictors were assessed using regression and Kaplan-Meier analysis (SPSS). Results Patients were predominantly male (1.45:1), median age 60.1 years. Blood culture was the primary diagnostic specimen (33.5%); 35.2% were polymicrobial. Among 88 blood culture-positive cases, 77.3% detected solely in aerobic bottles (mean TTP 39.1h). C. albicans predominated (52.6% of isolates); resistance: fluconazole 5.8%, itraconazole 11.0%, voriconazole 7.0%. Primary infection sources: abdominal (46.6%), catheter (18.8%). Overall mortality was 46.2%, varying by focus: bloodstream infection (BSI: 70.3%), abdominal (43.2%), catheter (26.1%); joint infections: 0%. In single-species infections (n = 140), PCT demonstrated highest diagnostic value (AUC 0.827; sensitivity 0.667, specificity 0.862 at 0.778 µg/mL). Fluconazole conferred superior 90-day survival vs. caspofungin (0.815 vs 0.330; p < 0.001). Regression identified significant mortality predictors: PCT ≥ 0.778 ng/mL (OR 3.800, 95% CI 1.995–7.237, p < 0.001), IL-6 ≥ 25.375 pg/mL (OR 3.667, 95% CI 1.372–9.795, p = 0.01), BSIs (OR 4.431, 95% CI 2.438–8.054, p < 0.001), ICU admission (OR 2.351, 95% CI 1.269–4.356, p = 0.007); Fluconazole was protective (OR 0.102, 95% CI 0.033–0.316). Conclusion IC mortality (46.2%) was highest in BSIs (70.3%). Elevated PCT, IL-6, and BSI are significant predictors. Fluconazole is protective. C. albicans (52.6%) and abdominal infections (46.6%) predominated. Invasive Candidiasis Mortality Risk Factors BISs Source of infection Biomarkers Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Invasive candidiasis (IC), a group of infectious syndromes caused by Candida spp., is associated with significant morbidity and mortality. Candidemia, a severe form of IC characterized by bloodstream invasion and disseminated infection, carries a particularly high mortality rate of 56.7% [1]. Definitive diagnosis of candidemia relies on blood culture isolation of Candida spp. However, false-negative blood cultures remain a major diagnostic challenge. Identifying the source of infection, which often precedes candidemia, is crucial for the early recognition of IC. Biomarkers such as β-D-glucan (G-test), procalcitonin (PCT), white blood cell count (WBC), and interleukin-6 (IL-6) are transforming microbiological diagnosis and infection assessment [2]. Nevertheless, their diagnostic value for IC specifically remains uncertain. Therefore, this study aims to investigate infection sources and evaluate the potential of these biomarkers for the early diagnosis of IC, with the ultimate goal of preventing candidemia. Materials and Methods 1.1 Study Design Annotation: Selection criteria for confirmed cases of invasive candidiasis [ 3 ] A positive Candida culture from at least one specimen obtained from a sterile site (including blood, cerebrospinal fluid, pleural fluid, peritoneal fluid, joint fluid, or pus). Abdominal drainage fluid and joint cavity drainage fluid (< 24 h) for cultivation to obtain Candida. Indwelling venous catheter ≥ 15CFU/tube of Candida at the 5 cm tip and the patient had clinical symptoms (elevated infection indicators or positive 1,3-beta-D-glucan). These data excluded all suspected cases of Candida infection identified in bile, abdominal drainage fluid, wound secretions, and the upper urinary tract. Recovery of Candida species from peritoneal fluid obtained via intra-abdominal drains likely represents colonization of the drain from the skin rather than true intra-abdominal infection. 1.2 Setting This retrospective study analyzed clinical data from the 940th Hospital of the Joint Logistics Support Force of the People’s Liberation Army. The cohort comprised patients diagnosed with culture-positive invasive Candida infection. Statistical analyses were performed on pathogen distribution, sample sources, admitting departments, underlying comorbidities, infection biomarkers, incidence rates, and in-hospital mortality. 1.3 Ethics This study received ethical approval from the [Ethics Committee of the 940th Hospital of the Joint Logistics Support Force of the People's Liberation Army (Clinical trial number: not applicable)] with a full waiver of both informed consent to participate and consent for publication, granted due to the retrospective nature of the research. This waiver comprehensively covers all aspects of the study, including data collection, analysis, and publication of anonymized results. We have revised the 'Ethics approval and consent to participate' section to explicitly state this information. The study was conducted in accordance with the ethical standards of the responsible institutional review board and the principles of the Declaration of Helsinki (1975, and its later amendments). 1.4 Participants Following a meticulous selection process, 223 participants were deemed eligible for the 12-month study period. A flowchart outlining participant eligibility and reasons for exclusion is presented. 1.5 Exposure Variables This study selected the following demographics and clinical characteristics as exposure variables: age, sex, coinfection, Fluconazole resistance, ICU hospitalization, bloodstream infection, Candida albicans infection, cancer, malignant hematological diseases, Usage of antifungal drugs, Medical related infection medical related infection,and laboratory biomarkers including procalcitonin (PCT), interleukin-6 (IL-6), serum (1,3)-β-D-glucan (β-D-glucan test), and neutrophil percentage (NEU%). 1.6 Endpoint Inpatients with ischemic cardiomyopathy (IC) died during hospitalization. 1.7 Microbiology Methods Infection biomarkers were collected from IC infection patients, specifically those detected within 24 hours of initial admission or within 24 hours of a positive Candida culture. The biomarkers and their detection methods were: procalcitonin (PCT; Roche chemiluminescence), C-reactive protein (CRP; Beckmann immunoturbidimetry), Interleukin-6 (IL-6; Roche chemiluminescence), white blood cell count (WBC; Mindray 6900), neutrophil percentage (N%; Mindray 6900), 1,3-beta-D-glucan (Beijing Jinshanchuan immunoturbidimetric method), and D-dimer (Hiesenmikon immunoturbidimetric assay). To prevent data duplication, only one biomarker result per patient was included. A negative control group comprised 200 uninfected patients. 1.8 Blood culture and General Fungal Culture Blood culture collection 10–20 ml of adult blood was drawn and immediately injected into BD blood culture bottles. Laboratory processing involved numbering, registering, and loading samples into a BD FX blood culture instrument. Upon positive alarm, staff observed the growth curve, aseptically extracted culture medium with a sterile syringe for Gram staining/microscopy, and reported results to clinicians. The medium was simultaneously inoculated onto plates for aerobic incubation at 35°C (24h). Following colony formation, organisms were identified using YST cards on a Vitek Compact-2 automated system. General Fungal Culture: Tissue blocks (1 cm³) from sterile surgical samples were inoculated onto whole blood agar plates. Sterile fluid specimens (ascites, puncture fluid, pus) were inoculated onto both blood agar and China blue agar plates. All samples underwent aerobic incubation at 35°C for 24 hours. Following colony formation, bacterial identification was performed using YST cards on the Vitek Compact-2 automated system. Candida Identification and Susceptibility Testing: Clinical samples underwent routine culture. Suspected Candida-positive cultures were incubated for 24 hours. After colony formation, Candida species identification utilized YST cards on the Vitek Compact-2. Additionally, antifungal susceptibility testing against 5-fluorocytosine, amphotericin B, fluconazole, itraconazole, and voriconazole was performed using the BioMérieux ATB FUNGUS 3 microdilution method, following CLSI M27-A guidelines for testing and interpretation. 1.9 Statistical Methods. Statistical analyses were performed using SPSS 22.0. Categorical variables (age, sex, and ICU status) were analyzed using Pearson’s χ² test. Multiple regression analysis identified statistically significant predictors of mortality (p < 0.05), with several factors reaching significance at p < 0.001. Survival curves for invasive candidiasis were generated using the Kaplan-Meier method. Finally, the sensitivity and specificity of clinical infection biomarkers were assessed via receiver operating characteristic (ROC) curve analysis. Results 3.1 Clinical features of IC patients A cohort of 223 inpatients with invasive candidiasis (IC), diagnosed by microbiological confirmation between 2013 and 2024, was analyzed. The incidence rate was 31.9 per 100,000 patient-years. The Medical related infection at 60%.The male-to-female ratio was 1.45:1, and the median age was 60.1 years (IQR 49.0–72.0).Blood culture was the primary diagnostic specimen (33.5%, 78/223 cases), followed by ascites (27.0%), pus (18.0%), and catheter tips (9.9%). Polymicrobial infections occurred in 35.2% of cases, with 10 patients confirmed by specimens from two distinct sites.Among 88 blood culture-positive IC cases, 77.3% were detected in aerobic bottles only (mean time-to-positivity: 39.1 ± 26.7 hours; range 3–140 hours), 18.2% in both aerobic and anaerobic bottles, and 4.5% in anaerobic bottles only (mean time-to-positivity: 24.1 ± 15.2 hours; range 3–54 hours).A total of 247 strains were isolated from the 223 patients. Candida albicans was predominant (52.6%). Antifungal susceptibility testing revealed resistance rates of 5.8% to fluconazole, 11.0% to itraconazole, and 7.0% to voriconazole. Resistant strains included C. albicans (n = 7), C. tropicalis (n = 7), C. glabrata (n = 3), and C. parapsilosis (n = 2) (Fig. 1 ). 3.2 Infection source and underlying diseases in IC patients Analysis of infection sources revealed abdominal infection as the primary site (46.6%). This was followed by catheter-related infections (18.8%), joint infections (5.4%), maxillofacial space infections (4.0%), and chest infections (2.7%). The source remained unknown in 35 cases (15.7%) ( Fig. 2 ). Analysis of underlying diseases/comorbidities identified over 30 distinct conditions among IC patients. The most prevalent critically ill conditions were peritonitis (15.6%, n = 31), malignant hematological diseases (7.6%), intestinal malignancies (7.2%), digestive tract perforation (6.7%), and postoperative gastric malignancies (4.9%) ( Table 1 ). 3.3 ROC curve analysis for the biomarker diagnostic value for IC The discriminatory ability of biomarkers for invasive candidiasis (IC) was evaluated in a cohort of 140 cases with single-species Candida spp. infection. Diagnostic performance, determined by the AUC-ROC for each biomarker, is presented in Fig. 3 and Table 2 . The most useful biomarker was procalcitonin (PCT), achieving an AUC-ROC of 0.827. At its optimal cut-off value of 0.778 µg/mL, PCT demonstrated a sensitivity of 0.667 and a specificity of 0.862. D-dimer showed superior discriminatory power with an AUC-ROC of 0.913. At its optimal cut-off of 2.600 mg/L, D-dimer yielded a sensitivity of 0.833 and a specificity of 0.914. 3.4 Kaplain Meier Survival Curve and mortality risk factors in IC patients The overall hospital mortality rate for invasive candidiasis (IC) patients was 46.2% (103/223). Mortality varied significantly by infection focus (χ²=33.099, p < 0.001): highest in bloodstream infections (BSIs) (70.3%, 52/74), followed by abdominal infections (43.2%, 38/88) and catheter-related infections (26.1%, 6/23). No mortality occurred in joint infections (0/12).Kaplan-Meier analysis demonstrated: No significant 30-day survival difference between antifungal-treated (capsafungin/fluconazole/voriconazole; 0.666 ± 0.057) and untreated groups (0.671 ± 0.053; Log-rank χ²=0.003, p = 0.958; Fig. 4 A).Superior 90-day survival with fluconazole (0.815 ± 0.090) versus caspofungin (0.330 ± 0.093; Log-rank χ²=12.244, p < 0.001; Fig. 4 B).Multiple regression identified significant mortality predictors (Fig. 5 , Table 3 ):PCT ≥ 0.778 ng/mL (OR 3.800, 95% CI 1.995–7.237, p < 0.001),IL-6 ≥ 25.375 pg/mL (OR 3.667, 95% CI 1.372–9.795, p = 0.01),BSI diagnosis (OR 4.431, 95% CI 2.438–8.054, p < 0.001), ICU admission (OR 2.351, 95% CI 1.269–4.356, p = 0.007),Fluconazole usage (OR = 0.102 ; 95% CI: 0.033–0.316). Discussions Invasive candidiasis (IC), a severe infectious disease caused by Candida species, demonstrated a hospital mortality rate of 46.2% in our study. This aligns with Logan C [ 4 ] , who reported IC crude mortality rates of 40–55% in ICU settings over the past decade. Our observed incidence rate of 31.9 per 100,000 persons exceeds the 2–14 per 100,000 reported by Soriano A [ 5 ] .Laboratory-based diagnosis revealed blood culture as the most common method (33.5%). Consistent with this finding, bloodstream infections (BSIs) exhibited the highest mortality among IC patients in our cohort (70.3%), significantly exceeding rates for abdominal infections (43.2%), catheter-related infections (26.1%), and joint infections (0%). This underscores BSIs as the most severe manifestation of IC, warranting heightened therapeutic attention. Among IC patients with positive blood cultures, 77.3% of detections occurred in aerobic bottles alone (mean time to positivity: 39.1 ± 26.7 hours), while 18.2% were detected in both aerobic and anaerobic bottles. Only 4.5% were detected solely in anaerobic bottles, with a significantly shorter mean time to positivity (24.1 ± 15.2 hours). These findings support the necessity of extending blood culture incubation to at least 7 days and utilizing both aerobic and anaerobic bottles for suspected candidemia.We isolated 247 strains representing 10 Candida species. C. albicans was the predominant pathogen (52.6%), and 8.5% of isolates were acquired resistant strains, consistent with prior reports [ 6 – 8 ] . Abdominal infections constituted the most common infection source (46.6%), followed by catheter-related infections (18.8%). The high prevalence of abdominal involvement likely relates to intestinal colonization by Candida species, which occurs in up to 60% of individuals [ 9 ] . Disruption of the commensal microbial equilibrium or intestinal damage can facilitate Candida overgrowth and invasion into the abdominal cavity.Patients presented with over 30 underlying conditions predisposing to IC. Peritonitis was the predominant comorbidity, followed by malignant hematological diseases, intestinal malignancies, digestive tract perforation, and postoperative gastric malignancies. This pattern reflects the established risk associated with abdominal surgery (particularly cases involving anastomotic leakage or repeat laparotomies), hematologic malignancies, solid-organ tumors [ 6 ] , and catheter-related bloodstream infections [ 10 ] . We evaluated the diagnostic performance of biomarkers for invasive candidiasis (IC) in patients with single-species infections (n = 140). Procalcitonin (PCT) demonstrated significant discriminatory power with an AUC-ROC of 0.827. At the optimal cut-off value of 0.778 µg/mL, PCT yielded a sensitivity of 0.667 and specificity of 0.862. In this cohort, PCT was the only biomarker showing clinically useful diagnostic value for IC. This finding contrasts with León C [ 11 ] , who reported no significant diagnostic utility for PCT (p = 0.179). Kaplan-Meier analysis revealed a 28-day survival rate of 0.591 ± 0.036 in our candidemia cohort, corresponding to a mortality rate of 50.1%. This exceeds the 35.1–40.0% mortality rates reported in prior studies [ 12 , 13 ] .Multiple regression modeling identified significant mortality risk factors for ischemic cardiomyopathy (IC):Procalcitonin (PCT) ≥ 0.778 ng/mL (OR 3.800, 95% CI 1.995–7.237; p < 0.001),IL-6 ≥ 25.375 pg/mL (OR 3.667, 95% CI 1.372–9.795; p = 0.01).Bloodstream infection (OR 4.431, 95% CI 2.438–8.054; p < 0.001),ICU admission (OR 2.351, 95% CI 1.269–4.356; p = 0.007),Fluconazole use (protective: OR 0.102, 95% CI 0.033–0.316; p < 0.001).Notably, fluconazole administration significantly reduced IC mortality. However, antifungal initiation was delayed (mean culture time: 35.7 ± 25.7 h), highlighting the importance of early treatment—consistent with literature establishing prompt antifungal therapy and catheter removal as mortality-reduction cornerstones [ 14 ] . For ICU patients failing antibiotic therapy, empirical fluconazole may reduce mortality at acceptable cost [ 15 ] .Our findings contrast with Zeng et al. [ 16 ] , where C. albicans infection predicted mortality (HR 3.35; 95% CI 1.13–9.92; p = 0.029); our analysis showed no such association (p = 0.135). Regarding ICU admission, while Leroy et al. [ 17 ] reported no mortality difference by admission type, our results align with Al-Dorzi et al. [ 18 ] (OR 2.87; 95% CI 1.22–6.74). This study provides novel evidence for PCT, IL-6, and bloodstream infection as significant IC mortality predictors—factors infrequently reported in existing literature. Conclusion, invasive candidiasis (IC) high mortality (46.2%) and identifies elevated PCT, IL-6, and bloodstream infection (BSI) as novel, significant mortality predictors. Fluconazole use was strongly protective but treatment initiation was often delayed. BSI had the highest mortality (70.3%). C. albicans predominated (52.6%); abdominal infections were most common (46.6%). Limitation Although this article collected cases within the past 10 years, the sample set is still relatively small. And due to the difficulty in diagnosing invasive candidiasis, we did not track samples suspected of contamination. Declarations The study was approved by the 940th Hospital of the Joint Logistics Support Force of People’s Liberation of the PLA Committee for Medical and Health Research Ethics. The Ethics Committee waived the need for informed consent, as this was an observational study, the treatment of the patients was standard, and no samples were taken for the study. Funding statement : Gansu Provincial Science and Technology Plan(21JR11RA010). Acknowledgments We thank our competent technicians for their diligent and accurate work during the data-collection process. We would also like to thank the staff at the Microbiology Laboratory, the 940th Hospital of Joint Logistics Support Force of People’s Liberation, for consecutively including cases and sending registration forms to physicians treating patients in the wards. Competing interests The authors declare that they have no competing interests. Authors’ contributions FENG Qiang-sheng conceived the study and participated in the design, data collection, statistical analysis, data interpretation, and drafting of the manuscript. SONG Yue and Juan participated in the design, statistical analysis, data interpretation, and manuscript drafting. XiaoQin-ha participated in the design, statistical analysis, data interpretation, and manuscript drafting. All the authors have read and approved the final manuscript. Data availability statement The datasets generated during this study derive from de-identified patient records in Hospital (HIS) and Laboratory (LIS) Information Systems. Due to patient privacy requirements, the volume of source data, and their original documentation in Chinese (requiring translation for accessibility), these data are not publicly available. Processed datasets are available from the corresponding author upon reasonable request. Consent for publication All participants provided written informed consent for publication of the clinical data and associated images. All identifying information has been removed to protect patient anonymity. References Kutlu M, Sayın-Kutlu S, Alp-Çavuş S, Öztürk ŞB, Taşbakan M, Özhak B, Kaya O, Kutsoylu OE, Şenol-Akar Ş, Turhan Ö, Mermut G, Ertuğrul B, Pullukcu H, Çetin ÇB, Avkan-Oğuz V, Yapar N, Yeşim-Metin D, Ergin Ç. Mortality-associated factors of candidemia: a multi-center prospective cohort in Turkey. Eur J Clin Microbiol Infect Dis. 2022;41(4):597–607. 10.1007/s10096-021-04394-0 . Epub 2022 Jan 27. PMID: 35083558. 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Tables Table 1 Underlying diseases in patients with invasive candidiasis （ n=223case ） Underlying diseases Case % Underlying diseases Case % Peritonitis 31 13.9 Postoperative lung cancer 4 1.8 Malignant hematological diseases 17 7.6 Autoimmune diseases 3 1.4 Malignant tumors of the intestine 16 7.2 Diabetes 3 1.4 Digestive tract perforation 15 6.7 Skin and soft tissue 3 1.4 Postoperative gastric malignant tumor 11 4.9 Infectious endocarditis 3 1.4 Infection of the maxillofacial muscle space 10 4.5 Liver abscess 3 1.4 Joint replacement surgery Infection 10 4.5 Intestinal obstruction 3 1.4 Cirrhosis 10 4.5 Bladder tumor 3 1.4 Multiple injuries 10 4.5 Neonate 2 0.9 Gallbladder cancer 8 3.6 Intracranial infection 2 0.9 Severe pneumonia 8 3.6 Viral pneumonia 2 0.9 Severe acute pancreatitis 6 2.7 Alzheimer's disease 2 0.9 Uremia 6 2.7 Acute cerebrovascular disease 2 0.9 Pancreatic cancer 4 1.8 Gallstones and cholecystitis 2 0.9 Postoperative esophageal cancer 4 1.8 Others 20 9.0 Table 2 AUC for the biomarker diagnostic value in invasive candidiasis (Single infection,n=140 case) Biomarkers AUC value Cut-off value Sensitivity Specificity 95% Confidence interval Lower bound Upper bound PCT（ng/ml） 0.827 0.778 0.667 0.862 0.720 0.933 IL-6（ng/ml） 0.788 25.375 0.958 0.603 0.686 0.891 WBC（×109/L） 0.746 8.395 0.75 0.759 0.600 0.892 NEU%（%） 0.869 79.9 0.792 0.983 0.742 0.995 D-Dimer（mg/L） 0.913 2.6 0.833 0.914 0.849 0.978 G test（pg/ml） >100 0.500 0.600 Notes: G test: 1,3-β-D glucan test; PCT: procalcitonin; IL-6: Interleukin- 6; WBC: White blood cell; NEU%: Neutrophil %. Table 3 Demographic, clinical and laboratory, findings of patients on admission Demographics and clinical characteristics Total(n=218) Nonsurvivor (n=101) Survivor (n=117) p value Age, years 60(49.0-72.0) 59.0(50.0-70.5) 60.0（47.5-73.0） 0.685 Sex 0.073 Female 89(41%) 48(54%) 41(46%) Male 129(59%) 53(41%) 76(59%) Age 0.504 >=60 110(50%) 48(44%) 62(56%) <60 108(50%) 52(48%) 56(52%) Co-pathogen 0.091 Yes 87(40%) 46(53%) 41(47%) No 131(60%) 54(41%) 77(59%) Fluconazole 189 Drug resistance or intermediary 17(9%) 11(65%) 6(35%) 0.105 Sensitive 172(91%) 89(44%) 112(56%) ICU Hospitalization 0.005 Yes 56(26%) 35(63%) 21(37%) No 162(74%) 66(41%) 96(59%) Bloodstream infection <0.001 Yes 74(34%) 52(70%) 22(30%) No 144(66%) 49(34%) 95(66%) Candida albicans 0.135 Yes 118(54%) 49(42%) 69(58%) No 100(46%) 52(52%) 48(48%) Procalcitonin, ng/mL =778 96(55%) 56(58%) 40(42%) PCT=100 51(%) 28(55%) 23(45%) G value=25.375 102(79%) 51(50%) 51(50%) =79.9 145(76%) 70(48%) 75(52%) <79.9 45(24%) 15(30%) 30(70%) Medical related infection 0.127 Yes 128(60%) 63(48%) 66(52%) NO 87(40%) 33(38%) 54(62%) Usage of antifungal drugs 0.824 Yes 86(46%) 32(37%) 54(63%) NO 101(54%) 36(36%) 65(64%) Types of antifungal drugs <0.001 Capofenjin 31(36%) 19(61%) 12(39%) Fluconazole 43(50%) 6(14%) 37(86%) Voriconazole 12(14%) 7(58%) 5(42%) Administration time of antifungal drugs 0.104 24h 29(34%) 14(48%) 15(52%) 48h 12(14%) 6(50%) 6(50%) ≥72h 45(52%) 13(29%) 33(71%) Data are median (IQR) or n (%). p values were calculated by Mann-Whitney U test, χ2 test, or Fisher's exact test,as appropriate. The administration time of antifungal drugs is calculated by the time of submitting positive microbial samples. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7822150","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":565113472,"identity":"f78304c8-8b88-4823-aba0-4ef911c53924","order_by":0,"name":"Qiangsheng Feng","email":"","orcid":"","institution":"The 940th Hospital of Joint Logistics Support Force of People’s Liberation Army","correspondingAuthor":false,"prefix":"","firstName":"Qiangsheng","middleName":"","lastName":"Feng","suffix":""},{"id":565113473,"identity":"8840f6c2-9df2-4aee-b23e-a4f97e77a69e","order_by":1,"name":"Xiaoqin Ha","email":"","orcid":"","institution":"The 940th 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01:03:59","extension":"png","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":79772,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7822150/v1/6f399cd7eceaf2bea226ed19.png"},{"id":99192413,"identity":"a171ff40-2a91-4487-a0bc-841a946ec794","added_by":"auto","created_at":"2025-12-30 01:03:59","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":39475,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7822150/v1/a499b08ae62f3218d0c0b111.png"},{"id":99316554,"identity":"b8fe3c86-ea32-44d7-847e-594acf1b48f7","added_by":"auto","created_at":"2025-12-31 16:28:35","extension":"xml","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":67830,"visible":true,"origin":"","legend":"","description":"","filename":"5d04010d0bfa431b9c2d1792a93032631structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7822150/v1/e8a217c7d6a9b4fcfe90c746.xml"},{"id":99192414,"identity":"6f1993af-0c0d-4272-9889-d5dc825acb9a","added_by":"auto","created_at":"2025-12-30 01:03:59","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":77776,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7822150/v1/958782784ab96ca5e8176936.html"},{"id":99192395,"identity":"527b4614-c0e0-41e3-a9f0-52f9b28781cb","added_by":"auto","created_at":"2025-12-30 01:03:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":70920,"visible":true,"origin":"","legend":"\u003cp\u003e① Specimen Distribution \u0026amp; Co-pathogens:\u003c/p\u003e\n\u003cp\u003eAmong confirmed invasive candidiasis (IC) cases, blood culture was the most frequent initial diagnostic specimen (33.5%), followed by ascitic fluid (27.0%), catheter tips (18.0%), and pus (9.9%). Polymicrobial infections (co-pathogens) were identified in 35.2% of total cases. Ten cases were confirmed using ≥2 specimen types.\u003c/p\u003e\n\u003cp\u003e② Blood Culture Characteristics:For culture-positive IC bloodstream infections, 77.3% were detected only in aerobic bottles (mean time-to-positivity: 39.1 ± 26.7 hours; range: 3–140 hours).\u003c/p\u003e\n\u003cp\u003e③ Pathogen Distribution:We isolated 247 Candida strains representing 10 species. C. albicans was the predominant pathogen (52.6%).\u003c/p\u003e\n\u003cp\u003e④Resistance Patterns:Acquired resistance was observed in 17 isolates (6.9% of total). All isolates were wild-type for Amphotericin B. As expected, C. krusei isolates demonstrated intrinsic resistance to fluconazole.\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-7822150/v1/79377c93b815b8d7f71f2c1f.png"},{"id":99316572,"identity":"3c5cb0d4-3103-4a8d-96a5-83d5f6a7245a","added_by":"auto","created_at":"2025-12-31 16:28:36","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":216872,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eInvasive candidiasis infection source\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbdominal infections constituted the predominant source (46.6%), followed by catheter-related infections (18.8%). Less frequent sources included joint, maxillofacial space, and chest infections. Notably, 35 cases (15.7%) had undetermined infection origins.\u003c/p\u003e","description":"","filename":"fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-7822150/v1/d2e441da56451dbf9e82d75d.png"},{"id":99192396,"identity":"91f37bf1-3d6d-4351-9559-465cfd7dfe93","added_by":"auto","created_at":"2025-12-30 01:03:58","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":71216,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eROC curve for the biomarker diagnostic value in invasive candidiasis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study enrolled 140 patients with a single infection type to evaluate biomarkers for invasive candidiasis. The area under the receiver operating characteristic curve (AUC-ROC) for procalcitonin (PCT) was 0.827; at a cut-off value of 0.778 μg/mL, sensitivity and specificity were 66.7% and 86.2%, respectively.\u003c/p\u003e","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-7822150/v1/5a64588672ce40727903ba1e.png"},{"id":99317366,"identity":"e9f95b75-4e07-4662-b840-c87838f9a4d0","added_by":"auto","created_at":"2025-12-31 16:30:04","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":74836,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA Fig.2 A Kaplan-Meier survival curve of Antifungal drugs usage in IC patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAntifungal drugs usage (Capsofungin, Fluconazole and Voriconazole) VS Non- Antifungal drugs usage 30 days survival rate 0.666±0.057 VS 0.671 ± 0.053, \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;p=0.958.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eB Kaplan-Meier survival curve of Antifungal drugs in IC patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAntifungal drugs (Capsofungin, n=31cases) VS Antifungal drugs (Fluconazole, n=44cases) 90 days survival rate 0.330±0.093 VS 0.815 ± 0.090, \u0026nbsp;\u0026nbsp;p\u0026lt;0.001.\u003c/p\u003e","description":"","filename":"FIG.4.png","url":"https://assets-eu.researchsquare.com/files/rs-7822150/v1/ae4c6d972ef845f371067c24.png"},{"id":99192410,"identity":"c2204e62-6c3a-45f2-a8ab-006f67458e26","added_by":"auto","created_at":"2025-12-30 01:03:59","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":89417,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMortality risk factors analysis in invasive candidiasis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultiple regression analysis identified the following significant predictors of mortality in invasive candidiasis (p \u0026lt; 0.01):PCT ≥0.778 ng/mL (OR = 3.800; 95% CI: 1.995–7.237),IL-6 ≥ 25.375 pg/mL (OR = 3.667; 95% CI: 1.372–9.795),Bloodstream infection (OR = 4.431; 95% CI: 2.438–8.054),ICU admission/stay (OR = 2.351; 95% CI: 1.269–4.356), Fluconazole usage(OR =0.102 ;95% CI: 0.033–0.316).\u003c/p\u003e","description":"","filename":"Fig.5.png","url":"https://assets-eu.researchsquare.com/files/rs-7822150/v1/2fba0538c8115873a4a2f3ca.png"},{"id":99316450,"identity":"546e0969-933b-4047-888c-1a16aec8f5b8","added_by":"auto","created_at":"2025-12-31 16:28:29","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":152434,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Materials and Methods section.\u003c/p\u003e","description":"","filename":"Uf1.png","url":"https://assets-eu.researchsquare.com/files/rs-7822150/v1/dda4c8591cbc6a02cca372c4.png"},{"id":99905253,"identity":"3c33106c-9fb8-4e3d-886d-9f512d299376","added_by":"auto","created_at":"2026-01-09 16:39:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1610764,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7822150/v1/305bafd0-c81b-47c3-9f5e-5d6528200ea9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Bloodstream Invasion Dominates Mortality in Invasive Candidiasis: Single-center Insights on Abdominal Origins, Antifungal Efficacy, and Biomarker-Driven Prognosis","fulltext":[{"header":"Introduction","content":"Invasive candidiasis (IC), a group of infectious syndromes caused by Candida spp., is associated with significant morbidity and mortality. Candidemia, a severe form of IC characterized by bloodstream invasion and disseminated infection, carries a particularly high mortality rate of 56.7% [1]. Definitive diagnosis of candidemia relies on blood culture isolation of Candida spp. However, false-negative blood cultures remain a major diagnostic challenge. Identifying the source of infection, which often precedes candidemia, is crucial for the early recognition of IC. Biomarkers such as β-D-glucan (G-test), procalcitonin (PCT), white blood cell count (WBC), and interleukin-6 (IL-6) are transforming microbiological diagnosis and infection assessment [2]. Nevertheless, their diagnostic value for IC specifically remains uncertain. Therefore, this study aims to investigate infection sources and evaluate the potential of these biomarkers for the early diagnosis of IC, with the ultimate goal of preventing candidemia. "},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Study Design\u003c/h2\u003e \u003cp\u003e Annotation: Selection criteria for confirmed cases of invasive candidiasis \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eA positive Candida culture from at least one specimen obtained from a sterile site (including blood, cerebrospinal fluid, pleural fluid, peritoneal fluid, joint fluid, or pus).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAbdominal drainage fluid and joint cavity drainage fluid (\u0026lt;\u0026thinsp;24 h) for cultivation to obtain Candida.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eIndwelling venous catheter\u0026thinsp;\u0026ge;\u0026thinsp;15CFU/tube of Candida at the 5 cm tip and the patient had clinical symptoms (elevated infection indicators or positive 1,3-beta-D-glucan).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThese data excluded all suspected cases of Candida infection identified in bile, abdominal drainage fluid, wound secretions, and the upper urinary tract. Recovery of Candida species from peritoneal fluid obtained via intra-abdominal drains likely represents colonization of the drain from the skin rather than true intra-abdominal infection.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Setting\u003c/h2\u003e \u003cp\u003eThis retrospective study analyzed clinical data from the 940th Hospital of the Joint Logistics Support Force of the People\u0026rsquo;s Liberation Army. The cohort comprised patients diagnosed with culture-positive invasive Candida infection. Statistical analyses were performed on pathogen distribution, sample sources, admitting departments, underlying comorbidities, infection biomarkers, incidence rates, and in-hospital mortality.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.3 Ethics\u003c/h2\u003e \u003cp\u003e This study received ethical approval from the [Ethics Committee of the 940th Hospital of the Joint Logistics Support Force of the People's Liberation Army (Clinical trial number: not applicable)] with a full waiver of both informed consent to participate and consent for publication, granted due to the retrospective nature of the research. This waiver comprehensively covers all aspects of the study, including data collection, analysis, and publication of anonymized results. We have revised the 'Ethics approval and consent to participate' section to explicitly state this information. The study was conducted in accordance with the ethical standards of the responsible institutional review board and the principles of the Declaration of Helsinki (1975, and its later amendments).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e1.4 Participants\u003c/h2\u003e \u003cp\u003eFollowing a meticulous selection process, 223 participants were deemed eligible for the 12-month study period. A flowchart outlining participant eligibility and reasons for exclusion is presented.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e1.5 Exposure Variables\u003c/h2\u003e \u003cp\u003eThis study selected the following demographics and clinical characteristics as exposure variables: age, sex, coinfection, Fluconazole resistance, ICU hospitalization, bloodstream infection, Candida albicans infection, cancer, malignant hematological diseases, Usage of antifungal drugs,\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical related\u0026nbsp;infection\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003emedical related infection,and laboratory biomarkers including procalcitonin (PCT), interleukin-6 (IL-6), serum (1,3)-β-D-glucan (β-D-glucan test), and neutrophil percentage (NEU%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e1.6 Endpoint\u003c/h2\u003e \u003cp\u003eInpatients with ischemic cardiomyopathy (IC) died during hospitalization.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e1.7 Microbiology Methods\u003c/h2\u003e \u003cp\u003eInfection biomarkers were collected from IC infection patients, specifically those detected within 24 hours of initial admission or within 24 hours of a positive Candida culture. The biomarkers and their detection methods were: procalcitonin (PCT; Roche chemiluminescence), C-reactive protein (CRP; Beckmann immunoturbidimetry), Interleukin-6 (IL-6; Roche chemiluminescence), white blood cell count (WBC; Mindray 6900), neutrophil percentage (N%; Mindray 6900), 1,3-beta-D-glucan (Beijing Jinshanchuan immunoturbidimetric method), and D-dimer (Hiesenmikon immunoturbidimetric assay). To prevent data duplication, only one biomarker result per patient was included. A negative control group comprised 200 uninfected patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e1.8 Blood culture and General Fungal Culture\u003c/h2\u003e \u003cp\u003eBlood culture collection 10\u0026ndash;20 ml of adult blood was drawn and immediately injected into BD blood culture bottles. Laboratory processing involved numbering, registering, and loading samples into a BD FX blood culture instrument. Upon positive alarm, staff observed the growth curve, aseptically extracted culture medium with a sterile syringe for Gram staining/microscopy, and reported results to clinicians. The medium was simultaneously inoculated onto plates for aerobic incubation at 35\u0026deg;C (24h). Following colony formation, organisms were identified using YST cards on a Vitek Compact-2 automated system.\u003c/p\u003e \u003cp\u003eGeneral Fungal Culture: Tissue blocks (1 cm\u0026sup3;) from sterile surgical samples were inoculated onto whole blood agar plates. Sterile fluid specimens (ascites, puncture fluid, pus) were inoculated onto both blood agar and China blue agar plates. All samples underwent aerobic incubation at 35\u0026deg;C for 24 hours. Following colony formation, bacterial identification was performed using YST cards on the Vitek Compact-2 automated system.\u003c/p\u003e \u003cp\u003eCandida Identification and Susceptibility Testing: Clinical samples underwent routine culture. Suspected Candida-positive cultures were incubated for 24 hours. After colony formation, Candida species identification utilized YST cards on the Vitek Compact-2. Additionally, antifungal susceptibility testing against 5-fluorocytosine, amphotericin B, fluconazole, itraconazole, and voriconazole was performed using the BioM\u0026eacute;rieux ATB FUNGUS 3 microdilution method, following CLSI M27-A guidelines for testing and interpretation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e1.9 Statistical Methods.\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SPSS 22.0. Categorical variables (age, sex, and ICU status) were analyzed using Pearson\u0026rsquo;s χ\u0026sup2; test. Multiple regression analysis identified statistically significant predictors of mortality (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with several factors reaching significance at p\u0026thinsp;\u0026lt;\u0026thinsp;0.001. Survival curves for invasive candidiasis were generated using the Kaplan-Meier method. Finally, the sensitivity and specificity of clinical infection biomarkers were assessed via receiver operating characteristic (ROC) curve analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Clinical features of IC patients\u003c/h2\u003e \u003cp\u003eA cohort of 223 inpatients with invasive candidiasis (IC), diagnosed by microbiological confirmation between 2013 and 2024, was analyzed. The incidence rate was 31.9 per 100,000 patient-years. The Medical related infection at 60%.The male-to-female ratio was 1.45:1, and the median age was 60.1 years (IQR 49.0\u0026ndash;72.0).Blood culture was the primary diagnostic specimen (33.5%, 78/223 cases), followed by ascites (27.0%), pus (18.0%), and catheter tips (9.9%). Polymicrobial infections occurred in 35.2% of cases, with 10 patients confirmed by specimens from two distinct sites.Among 88 blood culture-positive IC cases, 77.3% were detected in aerobic bottles only (mean time-to-positivity: 39.1\u0026thinsp;\u0026plusmn;\u0026thinsp;26.7 hours; range 3\u0026ndash;140 hours), 18.2% in both aerobic and anaerobic bottles, and 4.5% in anaerobic bottles only (mean time-to-positivity: 24.1\u0026thinsp;\u0026plusmn;\u0026thinsp;15.2 hours; range 3\u0026ndash;54 hours).A total of 247 strains were isolated from the 223 patients. Candida albicans was predominant (52.6%). Antifungal susceptibility testing revealed resistance rates of 5.8% to fluconazole, 11.0% to itraconazole, and 7.0% to voriconazole. Resistant strains included C. albicans (n\u0026thinsp;=\u0026thinsp;7), C. tropicalis (n\u0026thinsp;=\u0026thinsp;7), C. glabrata (n\u0026thinsp;=\u0026thinsp;3), and C. parapsilosis (n\u0026thinsp;=\u0026thinsp;2) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Infection source and underlying diseases in IC patients\u003c/h2\u003e \u003cp\u003eAnalysis of infection sources revealed abdominal infection as the primary site (46.6%). This was followed by catheter-related infections (18.8%), joint infections (5.4%), maxillofacial space infections (4.0%), and chest infections (2.7%). The source remained unknown in 35 cases (15.7%) (\u003cb\u003eFig.\u0026nbsp;2\u003c/b\u003e). Analysis of underlying diseases/comorbidities identified over 30 distinct conditions among IC patients. The most prevalent critically ill conditions were peritonitis (15.6%, n\u0026thinsp;=\u0026thinsp;31), malignant hematological diseases (7.6%), intestinal malignancies (7.2%), digestive tract perforation (6.7%), and postoperative gastric malignancies (4.9%) (\u003cb\u003eTable\u0026nbsp;1\u003c/b\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.3 ROC curve analysis for the biomarker diagnostic value for IC\u003c/h2\u003e \u003cp\u003eThe discriminatory ability of biomarkers for invasive candidiasis (IC) was evaluated in a cohort of 140 cases with single-species Candida spp. infection. Diagnostic performance, determined by the AUC-ROC for each biomarker, is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cb\u003eTable\u0026nbsp;2\u003c/b\u003e. The most useful biomarker was procalcitonin (PCT), achieving an AUC-ROC of 0.827. At its optimal cut-off value of 0.778 \u0026micro;g/mL, PCT demonstrated a sensitivity of 0.667 and a specificity of 0.862. D-dimer showed superior discriminatory power with an AUC-ROC of 0.913. At its optimal cut-off of 2.600 mg/L, D-dimer yielded a sensitivity of 0.833 and a specificity of 0.914.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Kaplain Meier Survival Curve and mortality risk factors in IC patients\u003c/h2\u003e \u003cp\u003eThe overall hospital mortality rate for invasive candidiasis (IC) patients was 46.2% (103/223). Mortality varied significantly by infection focus (χ\u0026sup2;=33.099, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001): highest in bloodstream infections (BSIs) (70.3%, 52/74), followed by abdominal infections (43.2%, 38/88) and catheter-related infections (26.1%, 6/23). No mortality occurred in joint infections (0/12).Kaplan-Meier analysis demonstrated: No significant 30-day survival difference between antifungal-treated (capsafungin/fluconazole/voriconazole; 0.666\u0026thinsp;\u0026plusmn;\u0026thinsp;0.057) and untreated groups (0.671\u0026thinsp;\u0026plusmn;\u0026thinsp;0.053; Log-rank χ\u0026sup2;=0.003, p\u0026thinsp;=\u0026thinsp;0.958; Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA).Superior 90-day survival with fluconazole (0.815\u0026thinsp;\u0026plusmn;\u0026thinsp;0.090) versus caspofungin (0.330\u0026thinsp;\u0026plusmn;\u0026thinsp;0.093; Log-rank χ\u0026sup2;=12.244, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eB).Multiple regression identified significant mortality predictors (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, \u003cb\u003eTable\u0026nbsp;3\u003c/b\u003e):PCT\u0026thinsp;\u0026ge;\u0026thinsp;0.778 ng/mL (OR 3.800, 95% CI 1.995\u0026ndash;7.237, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001),IL-6\u0026thinsp;\u0026ge;\u0026thinsp;25.375 pg/mL (OR 3.667, 95% CI 1.372\u0026ndash;9.795, p\u0026thinsp;=\u0026thinsp;0.01),BSI diagnosis (OR 4.431, 95% CI 2.438\u0026ndash;8.054, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), ICU admission (OR 2.351, 95% CI 1.269\u0026ndash;4.356, p\u0026thinsp;=\u0026thinsp;0.007),Fluconazole usage (OR\u0026thinsp;=\u0026thinsp;0.102 ; 95% CI: 0.033\u0026ndash;0.316).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussions","content":"\u003cp\u003eInvasive candidiasis (IC), a severe infectious disease caused by Candida species, demonstrated a hospital mortality rate of 46.2% in our study. This aligns with Logan C \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e, who reported IC crude mortality rates of 40\u0026ndash;55% in ICU settings over the past decade. Our observed incidence rate of 31.9 per 100,000 persons exceeds the 2\u0026ndash;14 per 100,000 reported by Soriano A \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.Laboratory-based diagnosis revealed blood culture as the most common method (33.5%). Consistent with this finding, bloodstream infections (BSIs) exhibited the highest mortality among IC patients in our cohort (70.3%), significantly exceeding rates for abdominal infections (43.2%), catheter-related infections (26.1%), and joint infections (0%). This underscores BSIs as the most severe manifestation of IC, warranting heightened therapeutic attention.\u003c/p\u003e \u003cp\u003eAmong IC patients with positive blood cultures, 77.3% of detections occurred in aerobic bottles alone (mean time to positivity: 39.1\u0026thinsp;\u0026plusmn;\u0026thinsp;26.7 hours), while 18.2% were detected in both aerobic and anaerobic bottles. Only 4.5% were detected solely in anaerobic bottles, with a significantly shorter mean time to positivity (24.1\u0026thinsp;\u0026plusmn;\u0026thinsp;15.2 hours). These findings support the necessity of extending blood culture incubation to at least 7 days and utilizing both aerobic and anaerobic bottles for suspected candidemia.We isolated 247 strains representing 10 Candida species. C. albicans was the predominant pathogen (52.6%), and 8.5% of isolates were acquired resistant strains, consistent with prior reports \u003csup\u003e[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAbdominal infections constituted the most common infection source (46.6%), followed by catheter-related infections (18.8%). The high prevalence of abdominal involvement likely relates to intestinal colonization by Candida species, which occurs in up to 60% of individuals \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Disruption of the commensal microbial equilibrium or intestinal damage can facilitate Candida overgrowth and invasion into the abdominal cavity.Patients presented with over 30 underlying conditions predisposing to IC. Peritonitis was the predominant comorbidity, followed by malignant hematological diseases, intestinal malignancies, digestive tract perforation, and postoperative gastric malignancies. This pattern reflects the established risk associated with abdominal surgery (particularly cases involving anastomotic leakage or repeat laparotomies), hematologic malignancies, solid-organ tumors \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e, and catheter-related bloodstream infections \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWe evaluated the diagnostic performance of biomarkers for invasive candidiasis (IC) in patients with single-species infections (n\u0026thinsp;=\u0026thinsp;140). Procalcitonin (PCT) demonstrated significant discriminatory power with an AUC-ROC of 0.827. At the optimal cut-off value of 0.778 \u0026micro;g/mL, PCT yielded a sensitivity of 0.667 and specificity of 0.862. In this cohort, PCT was the only biomarker showing clinically useful diagnostic value for IC. This finding contrasts with Le\u0026oacute;n C \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e, who reported no significant diagnostic utility for PCT (p\u0026thinsp;=\u0026thinsp;0.179).\u003c/p\u003e \u003cp\u003eKaplan-Meier analysis revealed a 28-day survival rate of 0.591\u0026thinsp;\u0026plusmn;\u0026thinsp;0.036 in our candidemia cohort, corresponding to a mortality rate of 50.1%. This exceeds the 35.1\u0026ndash;40.0% mortality rates reported in prior studies \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e.Multiple regression modeling identified significant mortality risk factors for ischemic cardiomyopathy (IC):Procalcitonin (PCT)\u0026thinsp;\u0026ge;\u0026thinsp;0.778 ng/mL (OR 3.800, 95% CI 1.995\u0026ndash;7.237; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001),IL-6\u0026thinsp;\u0026ge;\u0026thinsp;25.375 pg/mL (OR 3.667, 95% CI 1.372\u0026ndash;9.795; p\u0026thinsp;=\u0026thinsp;0.01).Bloodstream infection (OR 4.431, 95% CI 2.438\u0026ndash;8.054; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001),ICU admission (OR 2.351, 95% CI 1.269\u0026ndash;4.356; p\u0026thinsp;=\u0026thinsp;0.007),Fluconazole use (protective: OR 0.102, 95% CI 0.033\u0026ndash;0.316; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).Notably, fluconazole administration significantly reduced IC mortality. However, antifungal initiation was delayed (mean culture time: 35.7\u0026thinsp;\u0026plusmn;\u0026thinsp;25.7 h), highlighting the importance of early treatment\u0026mdash;consistent with literature establishing prompt antifungal therapy and catheter removal as mortality-reduction cornerstones \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. For ICU patients failing antibiotic therapy, empirical fluconazole may reduce mortality at acceptable cost \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e.Our findings contrast with Zeng et al. \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e, where C. albicans infection predicted mortality (HR 3.35; 95% CI 1.13\u0026ndash;9.92; p\u0026thinsp;=\u0026thinsp;0.029); our analysis showed no such association (p\u0026thinsp;=\u0026thinsp;0.135). Regarding ICU admission, while Leroy et al. \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e reported no mortality difference by admission type, our results align with Al-Dorzi et al. \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e (OR 2.87; 95% CI 1.22\u0026ndash;6.74). This study provides novel evidence for PCT, IL-6, and bloodstream infection as significant IC mortality predictors\u0026mdash;factors infrequently reported in existing literature.\u003c/p\u003e \u003cp\u003eConclusion, invasive candidiasis (IC) high mortality (46.2%) and identifies elevated PCT, IL-6, and bloodstream infection (BSI) as novel, significant mortality predictors. Fluconazole use was strongly protective but treatment initiation was often delayed. BSI had the highest mortality (70.3%). C. albicans predominated (52.6%); abdominal infections were most common (46.6%).\u003c/p\u003e \u003cp\u003e \u003cb\u003eLimitation\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAlthough this article collected cases within the past 10 years, the sample set is still relatively small. And due to the difficulty in diagnosing invasive candidiasis, we did not track samples suspected of contamination.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003eThe study was approved by the 940th Hospital of the Joint Logistics Support Force of People\u0026rsquo;s Liberation of the PLA Committee for Medical and Health Research Ethics. The Ethics Committee waived the need for informed consent, as this was an observational study, the treatment of the patients was standard, and no samples were taken for the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGansu Provincial Science and Technology Plan(21JR11RA010).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank our competent technicians for their diligent and accurate work during the data-collection process. We would also like to thank the staff at the Microbiology Laboratory, the 940th Hospital of Joint Logistics Support Force of People\u0026rsquo;s Liberation, for consecutively including cases and sending registration forms to physicians treating patients in the wards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFENG Qiang-sheng conceived the study and participated in the design, data collection, statistical analysis, data interpretation, and drafting of the manuscript. SONG Yue and Juan participated in the design, statistical analysis, data interpretation, and manuscript drafting. XiaoQin-ha participated in the design, statistical analysis, data interpretation, and manuscript drafting. All the authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during this study derive from de-identified patient records in Hospital (HIS) and Laboratory (LIS) Information Systems. Due to patient privacy requirements, the volume of source data, and their original documentation in Chinese (requiring translation for accessibility), these data are not publicly available. Processed datasets are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided written informed consent for publication of the clinical data and associated images. All identifying information has been removed to protect patient anonymity.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKutlu M, Sayın-Kutlu S, Alp-\u0026Ccedil;avuş S, \u0026Ouml;zt\u0026uuml;rk ŞB, Taşbakan M, \u0026Ouml;zhak B, Kaya O, Kutsoylu OE, Şenol-Akar Ş, Turhan \u0026Ouml;, Mermut G, Ertuğrul B, Pullukcu H, \u0026Ccedil;etin \u0026Ccedil;B, Avkan-Oğuz V, Yapar N, Yeşim-Metin D, Ergin \u0026Ccedil;. Mortality-associated factors of candidemia: a multi-center prospective cohort in Turkey. Eur J Clin Microbiol Infect Dis. 2022;41(4):597\u0026ndash;607. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10096-021-04394-0\u003c/span\u003e\u003cspan address=\"10.1007/s10096-021-04394-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2022 Jan 27. 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PMID: 31699043; PMCID: PMC6836498.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeroy O, Gangneux JP, Montravers P et al. Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005\u0026ndash;2006). Crit Care Med. 2009;37(5):1612-8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/CCM.0b013e31819efac0\u003c/span\u003e\u003cspan address=\"10.1097/CCM.0b013e31819efac0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 19325476.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Dorzi HM, Sakkijha H, Khan R, et al. Invasive Candidiasis in Critically Ill Patients: A Prospective Cohort Study in Two Tertiary Care Centers. J Intensive Care Med. 2020;35(6):542\u0026ndash;53. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0885066618767835\u003c/span\u003e\u003cspan address=\"10.1177/0885066618767835\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2018 Apr 8. PMID: 29628014; PMCID: PMC7222290.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1 Underlying diseases in patients with invasive candidiasis\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003en=223case\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41.6667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnderlying diseases\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCase\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4167%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28.125%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnderlying diseases\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCase\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.29167%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41.6667%;\"\u003e\n \u003cp\u003ePeritonitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4167%;\"\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.125%;\"\u003e\n \u003cp\u003ePostoperative lung cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.29167%;\"\u003e\n \u003cp\u003e1.8\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41.6667%;\"\u003e\n \u003cp\u003eMalignant hematological diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4167%;\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.125%;\"\u003e\n \u003cp\u003eAutoimmune diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.29167%;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41.6667%;\"\u003e\n \u003cp\u003eMalignant tumors of the intestine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4167%;\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.125%;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.29167%;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41.6667%;\"\u003e\n \u003cp\u003eDigestive tract perforation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4167%;\"\u003e\n \u003cp\u003e6.7\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.125%;\"\u003e\n \u003cp\u003eSkin and soft tissue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.29167%;\"\u003e\n \u003cp\u003e1.4\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41.6667%;\"\u003e\n \u003cp\u003ePostoperative gastric malignant tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4167%;\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.125%;\"\u003e\n \u003cp\u003eInfectious endocarditis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.29167%;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41.6667%;\"\u003e\n \u003cp\u003eInfection of the maxillofacial muscle space\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4167%;\"\u003e\n \u003cp\u003e4.5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.125%;\"\u003e\n \u003cp\u003eLiver abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.29167%;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41.6667%;\"\u003e\n \u003cp\u003eJoint replacement surgery Infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4167%;\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.125%;\"\u003e\n \u003cp\u003eIntestinal obstruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.29167%;\"\u003e\n \u003cp\u003e1.4\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41.6667%;\"\u003e\n \u003cp\u003eCirrhosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4167%;\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.125%;\"\u003e\n \u003cp\u003eBladder tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.29167%;\"\u003e\n \u003cp\u003e1.4\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41.6667%;\"\u003e\n \u003cp\u003eMultiple injuries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4167%;\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.125%;\"\u003e\n \u003cp\u003eNeonate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.29167%;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41.6667%;\"\u003e\n \u003cp\u003eGallbladder cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4167%;\"\u003e\n \u003cp\u003e3.6\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.125%;\"\u003e\n \u003cp\u003eIntracranial infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.29167%;\"\u003e\n \u003cp\u003e0.9\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41.6667%;\"\u003e\n \u003cp\u003eSevere pneumonia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4167%;\"\u003e\n \u003cp\u003e3.6\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.125%;\"\u003e\n \u003cp\u003eViral pneumonia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.29167%;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41.6667%;\"\u003e\n \u003cp\u003eSevere acute pancreatitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4167%;\"\u003e\n \u003cp\u003e2.7\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.125%;\"\u003e\n \u003cp\u003eAlzheimer\u0026apos;s disease\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.29167%;\"\u003e\n \u003cp\u003e0.9\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41.6667%;\"\u003e\n \u003cp\u003eUremia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4167%;\"\u003e\n \u003cp\u003e2.7\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.125%;\"\u003e\n \u003cp\u003eAcute cerebrovascular disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.29167%;\"\u003e\n \u003cp\u003e0.9\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41.6667%;\"\u003e\n \u003cp\u003ePancreatic cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4167%;\"\u003e\n \u003cp\u003e1.8\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.125%;\"\u003e\n \u003cp\u003eGallstones and cholecystitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.29167%;\"\u003e\n \u003cp\u003e0.9\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41.6667%;\"\u003e\n \u003cp\u003ePostoperative esophageal cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4167%;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.125%;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.25%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7.29167%;\"\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 AUC for the biomarker diagnostic value in invasive candidiasis (Single infection,n=140 case)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"599\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 111px;\"\u003e\n \u003cp\u003eBiomarkers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003eAUC value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 80px;\"\u003e\n \u003cp\u003eCut-off value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 69px;\"\u003e\n \u003cp\u003eSensitivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003eSpecificity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 198px;\"\u003e\n \u003cp\u003e95% Confidence interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eLower bound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eUpper bound\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003ePCT（ng/ml）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.827\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.778\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e0.667\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.862\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.720\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e0.933\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eIL-6（ng/ml）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.788\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e25.375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e0.958\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.603\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.686\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e0.891\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eWBC（\u0026times;109/L）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.746\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e8.395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.759\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e0.892\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eNEU%（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.869\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e79.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e0.792\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.983\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.742\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e0.995\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eD-Dimer（mg/L）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e0.833\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.914\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.849\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003e0.978\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eG test（pg/ml）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026gt;100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e0.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 118px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNotes: G test:\u0026nbsp;1,3-\u0026beta;-D glucan test;\u0026nbsp;PCT:\u0026nbsp;procalcitonin; IL-6:\u0026nbsp;Interleukin- 6; WBC:\u0026nbsp;White blood cell;\u0026nbsp;NEU%:\u0026nbsp;Neutrophil %.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Demographic, clinical and laboratory, findings of patients on admission\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eDemographics and clinical characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003eTotal(n=218)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003eNonsurvivor\u003c/p\u003e\n \u003cp\u003e(n=101)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003eSurvivor\u003c/p\u003e\n \u003cp\u003e(n=117)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e60(49.0-72.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e59.0(50.0-70.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e60.0（47.5-73.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.685\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e89(41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e48(54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e41(46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e129(59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e53(41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e76(59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.504\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026gt;=60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e110(50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e48(44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e62(56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026lt;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e108(50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e52(48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e56(52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eCo-pathogen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e87(40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e46(53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e41(47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e131(60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e54(41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e77(59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eFluconazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eDrug resistance or intermediary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e17(9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e11(65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6(35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSensitive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e172(91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e89(44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e112(56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eICU Hospitalization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e56(26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e35(63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e21(37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e162(74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e66(41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e96(59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eBloodstream infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e74(34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e52(70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e22(30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e144(66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e49(34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e95(66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eCandida albicans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.135\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e118(54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e49(42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e69(58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e100(46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e52(52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e48(48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eProcalcitonin, ng/mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePCT\u0026gt;=778\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e96(55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e56(58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e40(42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePCT\u0026lt;0.778\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e78(45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e21(27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e57(73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eG test(pg/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.239\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eG value\u0026gt;=100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e51(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e28(55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e23(45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eG value\u0026lt;100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e49(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e21(43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e28(57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eCancer and Malignant hematological diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e65(30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e36(55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e29(45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e153(70%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e65(42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e88(58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eIL-6（pg/ml）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026gt;=25.375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e102(79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e51(50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e51(50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026lt;25.375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e28(36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e6(21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e22(79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNEU%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026gt;=79.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e145(76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e70(48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e75(52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026lt;79.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e45(24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e15(30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e30(70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eMedical related\u0026nbsp;infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e128(60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e63(48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e66(52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e87(40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e33(38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e54(62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eUsage of antifungal drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.824\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e86(46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e32(37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e54(63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e101(54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e36(36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e65(64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eTypes of antifungal drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eCapofenjin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e31(36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e19(61%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e12(39%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eFluconazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e43(50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e6(14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e37(86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eVoriconazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e12(14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e7(58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e5(42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eAdministration time of antifungal drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e24h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e29(34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e14(48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e15(52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e48h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e12(14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e6(50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6(50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026ge;72h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e45(52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e13(29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e33(71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are median (IQR) or n (%). p values were calculated by Mann-Whitney U test, \u0026chi;2 test, or Fisher\u0026apos;s exact test,as appropriate. The administration time of antifungal drugs is calculated by the time of submitting positive microbial samples.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Invasive Candidiasis, Mortality Risk Factors, BISs, Source of infection, Biomarkers","lastPublishedDoi":"10.21203/rs.3.rs-7822150/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7822150/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eInvasive candidiasis (IC), particularly candidemia (56.7% mortality), faces diagnostic delays with blood cultures. Early identification of infection sources and biomarkers (PCT, IL-6, β-D-glucan) could enable prompt intervention.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA 12-month retrospective cohort study analyzed 223 hospitalized IC patients (2013\u0026ndash;2024; incidence 31.9/100,000 patient-years) confirmed by sterile-site mycological evidence. Biomarkers, microbiology (BD/Vitek, CLSI susceptibility), and mortality predictors were assessed using regression and Kaplan-Meier analysis (SPSS).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003ePatients were predominantly male (1.45:1), median age 60.1 years. Blood culture was the primary diagnostic specimen (33.5%); 35.2% were polymicrobial. Among 88 blood culture-positive cases, 77.3% detected solely in aerobic bottles (mean TTP 39.1h). C. albicans predominated (52.6% of isolates); resistance: fluconazole 5.8%, itraconazole 11.0%, voriconazole 7.0%. Primary infection sources: abdominal (46.6%), catheter (18.8%). Overall mortality was 46.2%, varying by focus: bloodstream infection (BSI: 70.3%), abdominal (43.2%), catheter (26.1%); joint infections: 0%. In single-species infections (n\u0026thinsp;=\u0026thinsp;140), PCT demonstrated highest diagnostic value (AUC 0.827; sensitivity 0.667, specificity 0.862 at 0.778 \u0026micro;g/mL). Fluconazole conferred superior 90-day survival vs. caspofungin (0.815 vs 0.330; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Regression identified significant mortality predictors: PCT\u0026thinsp;\u0026ge;\u0026thinsp;0.778 ng/mL (OR 3.800, 95% CI 1.995\u0026ndash;7.237, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), IL-6\u0026thinsp;\u0026ge;\u0026thinsp;25.375 pg/mL (OR 3.667, 95% CI 1.372\u0026ndash;9.795, p\u0026thinsp;=\u0026thinsp;0.01), BSIs (OR 4.431, 95% CI 2.438\u0026ndash;8.054, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), ICU admission (OR 2.351, 95% CI 1.269\u0026ndash;4.356, p\u0026thinsp;=\u0026thinsp;0.007); Fluconazole was protective (OR 0.102, 95% CI 0.033\u0026ndash;0.316).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIC mortality (46.2%) was highest in BSIs (70.3%). Elevated PCT, IL-6, and BSI are significant predictors. Fluconazole is protective. C. albicans (52.6%) and abdominal infections (46.6%) predominated.\u003c/p\u003e","manuscriptTitle":"Bloodstream Invasion Dominates Mortality in Invasive Candidiasis: Single-center Insights on Abdominal Origins, Antifungal Efficacy, and Biomarker-Driven Prognosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-30 01:03:54","doi":"10.21203/rs.3.rs-7822150/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d5406e98-db58-48e3-a899-9b623fa3a19d","owner":[],"postedDate":"December 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-09T16:38:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-30 01:03:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7822150","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7822150","identity":"rs-7822150","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}