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Objective: Early diagnosis and treatment of candidemia in intensive care units (ICUs) remain a significant challenge globally because of the lack of well-established non-culture-based diagnostic methods. This study aimed to evaluate risk factors in critically ill ICU patients, develop a unique Candida score, and create a real-time polymerase chain reaction (PCR) assay for the early diagnosis of candidemia., Materials and Methods: The study was conducted in three phases: 1) Retrospective analysis of 100 ICU patients from İstanbul University-Cerrahpaşa between January 2017 and December 2018 to identify risk factors for invasive candidiasis, 2) development of Cerrahpaşa Candida score based on these findings, and 3) prospective evaluation of 75 ICU patients, applying the newly created Cerrahpaşa Candida score and implementing a rapid PCR-based test on whole blood samples. The PCR assay was part of a development study and was not used for scoring or clinical diagnostic evaluation. Specific primer pairs and EvaGreen® dye (Biotium Inc., USA) were used to differentiate between Candida albicans and Candida parapsilosis isolates through melting curve analysis of real-time PCR amplicons. The PCR test demonstrated a detection limit of 10 CFU/mL., Results: In the retrospective analysis, key risk factors for candidemia were identified, including sepsis, intra-abdominal infections, hospitalization within the last three months, prolonged antibiotic use (>1 week), Candida colonization, percutaneous endoscopic gastrostomy, central venous catheter, and acute kidney injury ( p< 0.05). During the prospective phase, which evaluated 75 ICU patients, a Cerrahpaşa Candida score cutoff value of ≥4 points was established as significantly associated with an increased risk of candidemia ( p <0.05). The Cerrahpaşa Candida score and PCR assay, targeting the internal transcribed spacer (ITS) and D1/D2 regions, showed clinical utility for early diagnosis., Conclusion: The Cerrahpaşa Candida score and real-time PCR test developed in this study offer promising tools for guiding antifungal therapy in ICU patients, potentially reducing unnecessary antifungal use. However, improvements in PCR sensitivity are necessary. Further multicenter studies with larger patient cohorts are recommended to validate the clinical effectiveness of these diagnostic tools., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Infectious Diseases and Clinical Microbiology.)

Objective: The study aimed to identify predictors of advanced fibrosis score and histological activity index (HAI) in HBeAg-positive patients to facilitate early disease detection and reduce the need for invasive biopsies., Materials and Methods: The single-center retrospective study included treatment-naïve HBeAg-positive chronic hepatitis B (CHB) patients. Patients with HAI ≥6 and/or fibrosis ≥2 were considered to have significant liver damage. Independent determinants were identified by univariate and multivariate logistic regression analysis. Cut-off values for variables were determined by receiver operating characteristics (ROCs) curve analysis., Results: The study enrolled a cohort of 66 patients, with 51.5% male and a median age of 26 (22.7-34.2) years. In assessing necroinflammation, no significant differences were observed in age and gender between patients with HAI <6 and HAI ≥6. However, patients with HAI ≥6 exhibited higher aspartate aminotransferase (AST) levels compared to those with HAI <6. Furthermore, lower albumin levels and platelet (PLT) counts, along with higher fibrosis-4 (FIB-4) scores, were associated with HAI ≥6. In the evaluation of fibrosis, while gender distribution did not differ significantly, patients with fibrosis grade ≥2 were older and had higher HAI scores, HAI ≥6 ratios, and FIB-4 scores compared to those with fibrosis grade <2. Multivariate analysis identified albumin as a significant predictor for both HAI ≥6 and fibrosis grade ≥2. The area under ROC (AUROC) values of albumin for predicting HAI ≥6 and fibrosis ≥2 were 0.696 and 0.698, respectively, indicating moderate predictive ability., Conclusion: Albumin was found to be an independent predictor of liver damage in HBeAg-positive CHB patients. The fact that the optimal threshold values detected for both HAI ≥6 and fibrosis ≥2 in this patient group were close to normal values suggests that clinicians should be more cautious in monitoring albumin levels and other pre-defined parameters to avoid delays in diagnosis., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Infectious Diseases and Clinical Microbiology.)

Objective: This study aimed to determine the predictors for significant hepatic abnormality (SHA), a treatment indication, by assessing demographic, laboratory, and radiological results of chronic hepatitis B (CHB) patients who underwent liver biopsy., Materials and Methods: In this retrospective study, individuals with untreated hepatitis B e-antigen (HBeAg)-negative CHB infection were enrolled. Multivariate analysis modeling was conducted with parameters identified as predictors for SHA in univariate analysis. Optimal threshold levels for variables to predict SHA in patients with chronic hepatitis B were determined based on receiver operating characteristic (ROC) curve analysis., Results: A total of 566 patients with untreated chronic hepatitis B were included in the cohort; 61% (345/566) were male, and the median age was 41 years (interquartile range [IQR]=34-50). Notably, 36.9% (209/566) had SHA. In the multivariate analysis, utilizing different models, age, gender, HBV-DNA, LDL, ALT, and platelet count were identified as the most reliable predictors for SHA in CHB patients. For predicting SHA, the area under the ROC curve values of HBV-DNA, AST, and ALT were 0.704 (sensitivity=62.8%, specificity=76.2%; p <0.0001), 0.747 (sensitivity=51.9%, specificity=88.9%; p <0.0001), and 0.737 (sensitivity=68.6%, specificity=68.4%; p <0.0001), respectively., Conclusion: In our study, age, male gender, ALT, AST, HBV-DNA, LDL cholesterol, platelet count, and FIB-4 score were independent predictors of SHA in HBeAg-negative chronic hepatitis B. The most sensitive parameters for SHA were LDL and ALT. The most specific parameters were age, AST, and APRI score. SHA may occur in patients with high HBV-DNA levels, even if ALT values are normal in HBeAg-negative patients., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Infectious Diseases and Clinical Microbiology.)