Novel model to predict risk of invasive fungal infection and fungal prophylaxis timing.

Patients on immunosuppressive drugs or those who are critically ill are at high risk for invasive fungal infections (IFIs). The assessment of IFI risk and the initiation of prophylaxis in these patients remain unclear. A nomogram model was developed to evaluate clinical and immune indicators in relation to IFI risk and validated by immunocompromised patients. High-risk patients, as identified by the model, were selected for a prospective randomized study to assess the efficacy of the model and timing of fungal prophylaxis initiation. Patients deemed high risk received either fluconazole or a placebo until IFI occurrence or risk downgrade for 90 days. We compared the incidence of IFI and mortality between the two groups. The nomogram, created from a training cohort ( IMPORTANCE: We still lack enough evidence to decide when and how to begin fungal prophylaxis in immunocompromised patients. A model based on immune function indicator is an effective tool for predicting risk of invasive fungal infection (IFI) in immunocompromised patients. Patients were collected to evaluate the performance of the model retrospectively and prospectively. CLINICAL TRIALS: This study is registered with the Chinese Clinical Trial Registry as ChiCTR2400079810.