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Desirability of outcome ranking (DOOR) for comparing diagnostic tools and early therapeutic choices in patients with suspected candidemia

  • Daniele Roberto GiacobbeEmail author
  • Alessio Signori
  • Mario Tumbarello
  • Riccardo Ungaro
  • Giovanni Sarteschi
  • Elisa Furfaro
  • Malgorzata Mikulska
  • Maurizio Sanguinetti
  • Brunella Posteraro
  • Angela Raffaella Losito
  • Gennaro De Pascale
  • Valerio Del Bono
  • Claudio Viscoli
Original Article

Abstract

Desirability of outcome ranking (DOOR) has been developed for assessing desirability of outcome in interventional studies. However, its possible use in observational studies of the diagnosis and early treatment of infectious diseases has not been explored so far, and it might introduce interesting features in specific scenarios. This was a post hoc analysis of a prospective observational study in intensive care unit patients with sepsis and at risk of candidemia. The probabilities that a randomly selected patient would have a more, less, and equally cost-effective early therapeutic choice following a BDG-based diagnostic strategy rather than the empirical administration of antifungals to all patients were calculated using DOOR methods. The probability of a more cost-effective therapeutic choice following the BDG-based rather than the empirical strategy was 67.81% (95% CI 67.32–68.30), whereas the probabilities of a less and equally cost-effective early therapeutic choice were 19.68% (95% CI 19.27–20.10) and 12.50% (95% CI 12.16–12.85), respectively. The application of DOOR methods to observational studies focused on diagnosis and early treatment is a novel field that could merit further investigation.

Keywords

DOOR Glucan Candidemia Diagnosis Biomarker 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Not required because of the post hoc nature of the analyses. A waiver of informed consent was obtained in the original study.

Supplementary material

10096_2018_3441_MOESM1_ESM.pdf (184 kb)
ESM 1 (PDF 184 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Daniele Roberto Giacobbe
    • 1
    • 2
    Email author
  • Alessio Signori
    • 3
  • Mario Tumbarello
    • 4
  • Riccardo Ungaro
    • 1
    • 2
  • Giovanni Sarteschi
    • 1
    • 2
  • Elisa Furfaro
    • 2
  • Malgorzata Mikulska
    • 1
    • 2
  • Maurizio Sanguinetti
    • 5
  • Brunella Posteraro
    • 6
  • Angela Raffaella Losito
    • 4
  • Gennaro De Pascale
    • 7
  • Valerio Del Bono
    • 2
    • 8
  • Claudio Viscoli
    • 1
    • 2
  1. 1.Infectious Diseases Unit, Ospedale Policlinico San Martino – IRCCS per l’OncologiaUniversity of GenoaGenoaItaly
  2. 2.Department of Health Sciences, DISSALUniversity of GenoaGenoaItaly
  3. 3.Department of Health Sciences, Section of Biostatistics, DISSALUniversity of GenoaGenoaItaly
  4. 4.Institute of Infectious DiseasesFondazione Policlinico Universitario A. Gemelli IRCCS – Università Cattolica del Sacro CuoreRomeItaly
  5. 5.Institute of MicrobiologyFondazione Policlinico Universitario A. Gemelli IRCCS – Università Cattolica del Sacro CuoreRomeItaly
  6. 6.Institute of Public Health (Section of Hygiene)Fondazione Policlinico Universitario A. Gemelli IRCCS – Università Cattolica del Sacro CuoreRomeItaly
  7. 7.Dipartimento di Scienze dell’EmergenzaAnestesiologiche e della Rianimazione – UOC di Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica - Istituto di Anestesia e Rianimazione. Fondazione Policlinico Universitario A. Gemelli IRCCS – Università Cattolica del Sacro CuoreRomeItaly
  8. 8.Infectious Diseases UnitAzienda Ospedaliera S. Croce e CarleCuneoItaly

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