Predictors of invasive mycoses in children with immune-mediated inflammatory diseases hospitalized in the intensive care unit

Abstract

Introduction . Invasive fungal infections (IFIs) remain a significant problem, particularly in immunocompromised children, including patients receiving systemic corticosteroids and targeted therapy for autoimmune diseases. The objective was to identify risk factors for the development of invasive mycosis in patients with immune-mediated inflammatory diseases hospitalized in the intensive care unit (ICU). Materials and methods . This retrospective study included 51 patients (23 boys, 28 girls) aged 7 months to 17 years with systemic immune-mediated inflammatory diseases treated in the ICU of Saint Petersburg State Pediatric Medical University from 2007 to 2023. Depending on the fact of diagnosis, patients were divided into two groups: those who developed (n = 6) and those who did not develop (n = 45) invasive mycosis. Results . The development of IFIs in children with immune-mediated inflammatory diseases was associated with high underlying disease activity, severe clinical status (high pSOFA scores), and prolonged hospitalization (ICU stay of more than two weeks) (p = 0.004). Independent predictors of invasive mycosis included systemic rheumatic disease (p = 0.018), intensive immunosuppressive therapy (p = 0.122), a high pSOFA score, anemia (hemoglobin ≤ 69 g/L) (p = 0.0008), and hypoalbuminemia (albumin ≤ 30 g/L) (p = 0.033). IFIs are the significant factor for poor prognosis, associated with a significant increase in mortality (p < 0.05). Conclusion . The identified clinical and laboratory markers allow for risk stratification of patients, which is important for early diagnosis, timely treatment, and improved survival.