Performance of Repeated Measures of (1-3)-β-D-Glucan, Mannan Antigen, and Antimannan Antibodies for the Diagnosis of Invasive Candidiasis in ICU Patients: A Preplanned Ancillary Analysis of the EMPIRICUS Randomized Clinical Trial.
(1,3)-β-D-glucan
competing risk models
invasive candidiasis
Journal
Open forum infectious diseases
ISSN: 2328-8957
Titre abrégé: Open Forum Infect Dis
Pays: United States
ID NLM: 101637045
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
19
11
2020
accepted:
26
02
2021
entrez:
5
4
2021
pubmed:
6
4
2021
medline:
6
4
2021
Statut:
epublish
Résumé
We aimed to assess the prognostic value of repeated measurements of serum (1-3)-β-D-glucan (BDG), mannan-antigen (mannan-Ag), and antimannan antibodies (antimannan-Ab) for the occurrence of invasive candidiasis (IC) in a high-risk nonimmunocompromised population. This was a preplanned ancillary analysis of the EMPIRICUS Randomized Clinical Trial, including nonimmunocompromised critically ill patients with intensive care unit-acquired sepsis, multiple Two hundred thirty-four patients were included, and 215 were still alive and free of IC at day 3. IC developed in 27 patients (11.5%), and day 28 mortality was 29.1%. Finally, BDG >80 pg/mL at inclusion was associated with an increased risk of IC (CSHR[IC], 4.67; 95% CI, 1.61-13.5) but not death (CSHR[death], 1.20; 95% CI, 0.71-2.02). Among high-risk patients, a first measurement of BDG >80 pg/mL was strongly associated with the occurrence of IC. Neither a cutoff of 250 pg/mL nor repeated measurements of fungal biomarkers seemed to be useful to predict the occurrence of IC. The cumulative risk of IC in the placebo group if BDG >80 pg/mL was 25.39%, which calls into question the efficacy of empirical therapy in this subgroup.
Sections du résumé
BACKGROUND
BACKGROUND
We aimed to assess the prognostic value of repeated measurements of serum (1-3)-β-D-glucan (BDG), mannan-antigen (mannan-Ag), and antimannan antibodies (antimannan-Ab) for the occurrence of invasive candidiasis (IC) in a high-risk nonimmunocompromised population.
METHODS
METHODS
This was a preplanned ancillary analysis of the EMPIRICUS Randomized Clinical Trial, including nonimmunocompromised critically ill patients with intensive care unit-acquired sepsis, multiple
RESULTS
RESULTS
Two hundred thirty-four patients were included, and 215 were still alive and free of IC at day 3. IC developed in 27 patients (11.5%), and day 28 mortality was 29.1%. Finally, BDG >80 pg/mL at inclusion was associated with an increased risk of IC (CSHR[IC], 4.67; 95% CI, 1.61-13.5) but not death (CSHR[death], 1.20; 95% CI, 0.71-2.02).
CONCLUSIONS
CONCLUSIONS
Among high-risk patients, a first measurement of BDG >80 pg/mL was strongly associated with the occurrence of IC. Neither a cutoff of 250 pg/mL nor repeated measurements of fungal biomarkers seemed to be useful to predict the occurrence of IC. The cumulative risk of IC in the placebo group if BDG >80 pg/mL was 25.39%, which calls into question the efficacy of empirical therapy in this subgroup.
Identifiants
pubmed: 33816643
doi: 10.1093/ofid/ofab080
pii: ofab080
pmc: PMC8002176
doi:
Types de publication
Journal Article
Langues
eng
Pagination
ofab080Investigateurs
Rebecca Hamidfar-Roy
(R)
Magalie Ciroldi
(M)
Clichy Catherine Paugam-Burtz
(CC)
Arnaud Foucrier
(A)
Jean Christophe Navellou
(JC)
Michel Wolff
(M)
Jean-Francois Timsit
(JF)
Lila Bouadma
(L)
Bruno Mourvillier
(B)
Romain Sonneville
(R)
Sarah Chemam
(S)
Didier Gruson
(D)
Bertrand Souweine
(B)
Alexandre Lautrette
(A)
Pierre Emmanuel Charles
(PE)
Rémi Bruyere
(R)
Maël Hamet
(M)
Bernard Allaouchiche
(B)
Christian Guillaume
(C)
Charles-Eric Ber
(CE)
Johanne Prothet
(J)
Thomas Rimmele
(T)
Laurent Argaud
(L)
Marie Simon
(M)
Martin Cour
(M)
Romain Hernu
(R)
Samir Jaber
(S)
Boris Jung
(B)
Mathieu Conseil
(M)
Yannael Coisel
(Y)
Fouad Belafia
(F)
Kada Klouche
(K)
Laurent Amigues
(L)
Sonia Machado
(S)
Marianne Serveaux
(M)
Jean Chastre
(J)
Jean-Louis Trouillet
(JL)
Joël Cousson
(J)
Pascal Raclot
(P)
Thierry Floch
(T)
Fabrice Zeni
(F)
Michael Darmon
(M)
Matthias Pichon
(M)
Maud Coudrot
(M)
Sebastien Ninet
(S)
Eric Diconne
(E)
Benoit Schlemmer
(B)
Elie Azoulay
(E)
Virginie Lemiale
(V)
Nicolas Maziers
(N)
Ferhat Meziani
(F)
David Schnell
(D)
Julie Boisrame-Helms
(J)
Raluca Neagu-Anca
(R)
Xavier Delabranche
(X)
Olivier Martinet
(O)
Maité Garrouste-Orgeas
(M)
Benoit Misset
(B)
Fabrice Brunee
(F)
Virginie Laurent
(V)
Guillaume Lacave
(G)
Jean-Pierre Bedos
(JP)
Khadija Hammi
(K)
Lenka Styfalova
(L)
Joelle Fritzsch
(J)
Sophie Letrou
(S)
Lucie Estevez
(L)
Therese Devaux
(T)
Celine Dubien
(C)
Soumia Bayarassou
(S)
Catherine Jouvene Faure
(CJ)
Sylvie de La Salle
(S)
Albert Prades
(A)
Annie Rodriguez
(A)
Pierre Meur
(P)
Magda Warchol
(M)
Hanane El Haouari
(H)
Igor Theodose
(I)
Julien Fournier
(J)
Sebastien Cavelot
(S)
Lilia Bakir Kodja
(LB)
Marie Joyeux Faure
(MJ)
Frédéric Tacco
(F)
Sonia Roos
(S)
Karima Dupre
(K)
Malek Abazid
(M)
Michele Essert
(M)
Philippe Arnaud
(P)
Emmanuelle Papy
(E)
Bellabes Ghezzoul
(B)
Olivier Gerbouin
(O)
Sandrine Corny Peccoux
(SC)
Philippe Fagnoni
(P)
Anne Millaret
(A)
Christine Pivot
(C)
Cecile Gerard
(C)
Cyril Breuker
(C)
Audrey Castet
(A)
Fanny Charbonnier
(F)
Maryline Legrand
(M)
Julia Mordini
(J)
Isabelle Madeleine Chambrin
(IM)
Anne Hutt Clauss
(AH)
Mohamed Cherifi
(M)
Anne Pattyn
(A)
Murielle Cornet
(M)
Danièle Maubon
(D)
Eliane Benveniste
(E)
Fréderic Grenouillet
(F)
Christian Chochillon
(C)
Isabelle Accoberry
(I)
Denis Pons
(D)
Natacha Mrozek
(N)
Frédéric Dalle
(F)
Stephane Picot
(S)
Francoise Beyerle
(F)
Anne-Lise Bienvenu
(AL)
Nathalie Bourgeois
(N)
Arnaud Fekkar
(A)
Dominique Toubas
(D)
Hélène Raberin
(H)
Ermanno Candolfi
(E)
Valérie Bru
(V)
Marie Dominique Kitzis
(MD)
Yaye Senghor
(Y)
Catherine Palette
(C)
Stéphane Ruckly
(S)
Aurélien Vesin
(A)
Jean-Paul Mira
(JP)
Jean-Ralph Zahar
(JR)
Dominique Larrey
(D)
Jean-Pierre Zarski
(JP)
Jean-Ralph Zahar
(JR)
Jean-Paul Mira
(JP)
Dominique Larrey
(D)
Jean-Pierre Zarski
(JP)
Edith Schir
(E)
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
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