Quantification of 1,3-β-d-glucan by Wako β-glucan assay for rapid exclusion of invasive fungal infections in critical patients: A diagnostic test accuracy study.
Aged
Antifungal Agents
/ therapeutic use
Caspofungin
/ therapeutic use
Diagnostic Tests, Routine
/ methods
Female
Fluconazole
/ therapeutic use
Humans
Intensive Care Units
Invasive Fungal Infections
/ diagnosis
Limit of Detection
Male
Middle Aged
Predictive Value of Tests
Retrospective Studies
Sensitivity and Specificity
Voriconazole
/ therapeutic use
beta-Glucans
/ blood
antimycotic chemotherapy
candidaemia
deep fungal infection
immunodeficiency
peritonitis
surgery
systemic infection
Journal
Mycoses
ISSN: 1439-0507
Titre abrégé: Mycoses
Pays: Germany
ID NLM: 8805008
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
29
01
2020
revised:
12
08
2020
accepted:
13
08
2020
pubmed:
19
8
2020
medline:
2
2
2021
entrez:
19
8
2020
Statut:
ppublish
Résumé
Rapid and reliable exclusion of invasive fungal infections (IFI) by markers able to avoid unnecessary empirical antifungal treatment is still a critical unmet clinical need. We investigated the diagnostic performance of a newly available β-d-Glucan (BDG) quantification assay, focusing on the optimisation of the BDG cut-off values for IFI exclusion. BDG results by Wako β-glucan assay (lower limit of detection [LLOD] = 2.16 pg/mL, positivity ≥ 11 pg/mL) on two consecutive serum samples were retrospectively analysed in 170 patients, admitted to haematological wards (N = 42), intensive care units (ICUs; N = 80), or other wards (N = 48), exhibiting clinical signs and/or symptoms suspected for IFI. Only patients with proven IFI (EORTC/MSG criteria) were considered as true positives in the assessment of BDG sensitivity, specificity and predictive values. Patients were diagnosed with no IFI (69.4%), proven IFI (25.3%) or probable IFI (5.3%). Two consecutive BDG values < LLOD performed within a median of 1 (interquartile range: 1-3) day were able to exclude a proven IFI with 100% sensitivity and negative predictive value (primary study goal). Test's specificity improved by using two distinct positivity and negativity cut-offs (7.7 pg/mL and LLOD, respectively), but remained suboptimal in ICU patients (50%), as compared to haematological or other patients (93% and 90%, respectively). The classification of Wako's results as negative when < LLOD, and positive when > 7.7 pg/mL, could be a promising diagnostic approach to confidently rule out an IFI in both ICU and non-ICU patients. The poor specificity in the ICU setting remains a concern, due to the difficulty to interpret positive results in this fragile population.
Substances chimiques
Antifungal Agents
0
beta-Glucans
0
Fluconazole
8VZV102JFY
Caspofungin
F0XDI6ZL63
Voriconazole
JFU09I87TR
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1299-1310Informations de copyright
© 2020 Wiley-VCH GmbH.
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