Inadequate Proof of Adverse Outcome Due to the Use of Fluconazole in Critically Ill Patients

In reply

We read with interest the letter by Blot and colleagues from Belgium regarding our article recently published in the ARCHIVES. Both critically ill patient groups, receiving and not receiving fluconazole, were comparable regarding similar age, Acute Physiology and Chronic Health Evaluation (APACHE) III score on admission to the intensive care unit, rate of surgery, and percentage of diabetics. The APACHE III score was used in this study owing to its evaluation of age, physiology, and long-term health status of each patient and its accurate estimate of mortality for the first day in the intensive care unit.¹ However, the APACHE III score adjusts for the differing prognoses of patients who have different diseases but similar physiologic abnormalities. Thus, as Blot and coauthors had stated, the assignment of an underlying diagnosis can be important in estimating an accurate mortality prediction.²