Prognostic value of serial (1,3)-β-D-glucan measurements in ICU patients with invasive candidiasis.
(1, 3)-β-d-glucan
Biomarker
Downslope
Invasive candidiasis
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
12 Jul 2024
12 Jul 2024
Historique:
received:
06
05
2024
accepted:
06
07
2024
medline:
13
7
2024
pubmed:
13
7
2024
entrez:
12
7
2024
Statut:
epublish
Résumé
To determine whether a decrease in serum (1,3)-β-D-glucan (BDG) was associated with reduced mortality and to investigate the performance of BDG downslope in predicting clinical outcome in invasive candidiasis. Observational cohort study in ICU patients over a ten-year period (2012-2022) in Italy. Proven invasive candidiasis with at least 2 BDG determinations were considered. In the study population of 103 patients (age 47 [35-62] years, SAPS II score 67 [52-77]) 68 bloodstream and 35 intrabdominal infections were recorded. Serial measurements showed that in 54 patients BDG decreased over time (BDG downslope group) while in 49 did not (N-BDG downslope group). Candida albicans was the pathogen most frequently isolated (61%) followed by C. parapsilosis (17%) and C. glabrata (12%), in absence of any inter-group difference. Invasive candidiasis related mortality was lower in BDG downslope than in N-BDG downslope group (17% vs 53%, p < 0.01). The multivariate Cox regression analysis showed the association of septic shock at infection occurrence and chronic liver disease with invasive candidiasis mortality (HR [95% CI] 3.24 [1.25-8.44] p = 0.02 and 7.27 [2.33-22.66] p < 0.01, respectively) while a BDG downslope was the only predictor of survival (HR [95% CI] 0.19 [0.09-0.43] p < 0.01). The area under the receiver operator characteristic curve for the performance of BDG downslope as predictor of good clinical outcome was 0.74 (p = 0.02) and our model showed that a BDG downslope > 70% predicted survival with both specificity and positive predictive value of 100%. A decrease in serum BDG was associated with reduced mortality and a steep downslope predicted survival with high specificity in invasive candidiasis.
Sections du résumé
BACKGROUND
BACKGROUND
To determine whether a decrease in serum (1,3)-β-D-glucan (BDG) was associated with reduced mortality and to investigate the performance of BDG downslope in predicting clinical outcome in invasive candidiasis.
METHODS
METHODS
Observational cohort study in ICU patients over a ten-year period (2012-2022) in Italy. Proven invasive candidiasis with at least 2 BDG determinations were considered.
RESULTS
RESULTS
In the study population of 103 patients (age 47 [35-62] years, SAPS II score 67 [52-77]) 68 bloodstream and 35 intrabdominal infections were recorded. Serial measurements showed that in 54 patients BDG decreased over time (BDG downslope group) while in 49 did not (N-BDG downslope group). Candida albicans was the pathogen most frequently isolated (61%) followed by C. parapsilosis (17%) and C. glabrata (12%), in absence of any inter-group difference. Invasive candidiasis related mortality was lower in BDG downslope than in N-BDG downslope group (17% vs 53%, p < 0.01). The multivariate Cox regression analysis showed the association of septic shock at infection occurrence and chronic liver disease with invasive candidiasis mortality (HR [95% CI] 3.24 [1.25-8.44] p = 0.02 and 7.27 [2.33-22.66] p < 0.01, respectively) while a BDG downslope was the only predictor of survival (HR [95% CI] 0.19 [0.09-0.43] p < 0.01). The area under the receiver operator characteristic curve for the performance of BDG downslope as predictor of good clinical outcome was 0.74 (p = 0.02) and our model showed that a BDG downslope > 70% predicted survival with both specificity and positive predictive value of 100%.
CONCLUSIONS
CONCLUSIONS
A decrease in serum BDG was associated with reduced mortality and a steep downslope predicted survival with high specificity in invasive candidiasis.
Identifiants
pubmed: 38997712
doi: 10.1186/s13054-024-05022-x
pii: 10.1186/s13054-024-05022-x
doi:
Substances chimiques
beta-Glucans
0
polysaccharide-K
3X48A86C8K
Biomarkers
0
Proteoglycans
0
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
236Informations de copyright
© 2024. The Author(s).
Références
Calandra T, Roberts JA, Antonelli M, Bassetti M, Vincent J-L. Diagnosis and management of invasive candidiasis in the ICU: an updated approach to an old enemy. Crit Care. 2016;20:125.
doi: 10.1186/s13054-016-1313-6
pubmed: 27230564
pmcid: 4882871
Clancy CJ, Nguyen MH. Finding the “Missing 50%” of invasive candidiasis: How nonculture diagnostics will improve understanding of disease spectrum and transform patient care. Clin Infect Dis. 2013;56:1284–92.
doi: 10.1093/cid/cit006
pubmed: 23315320
Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the infectious diseases Society of America. Clinical infectious diseases. Oxford University Press; 2015. pp. e1–50.
Douglas CM. Fungal ß(1,3)-D-glucan synthesis. Med Mycol. 2001;39:55–66.
doi: 10.1080/mmy.39.1.55.66
pubmed: 11800269
De Carolis E, Marchionni F, Torelli R, Posteraro P, De Pascale G, Carelli S, et al. Comparable serum and plasma 1,3-β-D-glucan values using the Wako β-glucan test assay in patients with probable or proven fungal diseases. J Clin Microbiol. 2019;1–5.
De Pascale G, Tumbarello M. Fungal infections in the ICU: advances in treatment and diagnosis. Curr Opin Crit Care. Lippincott Williams and Wilkins; 2015. pp. 421–9.
De Pascale G, Posteraro B, D’Arrigo S, Spinazzola G, Gaspari R, Bello G, et al. (1,3)-β-D-Glucan-based empirical antifungal interruption in suspected invasive candidiasis: a randomized trial. Crit Care. 2020;24:550.
doi: 10.1186/s13054-020-03265-y
pubmed: 32891170
pmcid: 7487510
Giacobbe DR, Esteves P, Bruzzi P, Mikulska M, Furfaro E, Mesini A, et al. Initial serum (1,3)-β-D-glucan as a predictor of mortality in proven candidaemia: findings from a retrospective study in two teaching hospitals in Italy and Brazil. Clin Microbiol Infect. 2015;21(954):e9-17.
Jaijakul S, Vazquez JA, Swanson RN, Ostrosky-Zeichner L. (1,3)-β-D-glucan as a prognostic marker of treatment response in invasive candidiasis. Clin Infect Dis. 2012;55:521–6.
doi: 10.1093/cid/cis456
pubmed: 22573851
Dellinger RP, Levy M, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580–637.
doi: 10.1097/CCM.0b013e31827e83af
pubmed: 23353941
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43:304–77.
doi: 10.1007/s00134-017-4683-6
pubmed: 28101605
De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;46:1813–21.
doi: 10.1086/588660
pubmed: 18462102
Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA. 270:2957–63.
Ferreira FL, Bota DP, Bross A, Mélot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286:1754–8.
doi: 10.1001/jama.286.14.1754
pubmed: 11594901
Pickering JW, Sant HW, Bowles CAP, Roberts WL, Woods GL. Evaluation of a (1->3)-beta-D-glucan assay for diagnosis of invasive fungal infections. J Clin Microbiol. 2005;43:5957–62.
doi: 10.1128/JCM.43.12.5957-5962.2005
pubmed: 16333082
pmcid: 1317189
Lo Cascio G, Koncan R, Stringari G, Russo A, Azzini A, Ugolini A, et al. Interference of confounding factors on the use of (1,3)-beta-D-glucan in the diagnosis of invasive candidiasis in the intensive care unit. Eur J Clin Microbiol Infect Dis. 2015;34:357–65.
doi: 10.1007/s10096-014-2239-z
pubmed: 25217227
Cuenca-Estrella M, Verweij PE, Arendrup MC, Arikan-Akdagli S, Bille J, Donnelly JP, et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: diagnostic procedures. Clin Microbiol Infect. 2012;18(Suppl 7):9–18.
doi: 10.1111/1469-0691.12038
pubmed: 23137134
Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49:1–45.
doi: 10.1086/599376
pubmed: 19489710
Posteraro B, De Carolis E, Vella A, Sanguinetti M. MALDI-TOF mass spectrometry in the clinical mycology laboratory: identification of fungi and beyond. Expert Rev Proteomics. 2013;10:151–64.
doi: 10.1586/epr.13.8
pubmed: 23573782
Posteraro B, Spanu T, Fiori B, De Maio F, De Carolis E, Giaquinto A, et al. Antifungal susceptibility profiles of bloodstream yeast isolates by Sensititre YeastOne over nine years at a large Italian teaching hospital. Antimicrob Agents Chemother. 2015;59:3944–55.
doi: 10.1128/AAC.00285-15
pubmed: 25896705
pmcid: 4468684
Agnelli C, Bouza E, Del Carmen Martínez-Jiménez M, Navarro R, Valerio M, Machado M, et al. Clinical relevance and prognostic value of persistently negative (1,3) β-D-glucan in adults with candidemia: a 5-year experience in a tertiary hospital.
Bassetti M, Righi E, De Pascale G, De Gaudio R, Giarratano A, Mazzei T, et al. How to manage aspergillosis in non-neutropenic intensive care unit patients. Crit Care. BioMed Central Ltd.; 2014.
Petraitiene R, Petraitis V, Hope WW, Mickiene D, Kelaher AM, Murray HA, et al. Cerebrospinal fluid and plasma (1→3)-β-D-glucan as surrogate markers for detection and monitoring of therapeutic response in experimental hematogenous Candida meningoencephalitis. Antimicrob Agents Chemother. 2008;52:4121–9.
doi: 10.1128/AAC.00674-08
pubmed: 18779361
pmcid: 2573149
Pazos C, Pontón J, Del PA. Contribution of (1→3)-β-D-glucan chromogenic assay to diagnosis and therapeutic monitoring of invasive aspergillosis in neutropenic adult patients: a comparison with serial screening for circulating galactomannan. J Clin Microbiol. 2005;43:299–305.
doi: 10.1128/JCM.43.1.299-305.2005
pubmed: 15634986
pmcid: 540165
Cuétara MS, Alhambra A, Chaves F, Moragues MD, Pontón J, del Palacio A. Use of a serum (1→3)-β-d<-glucan assay for diagnosis and follow-up of Pneumocystis jiroveci pneumonia. Clin Infect Dis. 2008;47:1364–6.
doi: 10.1086/592753
pubmed: 18922079
Held J, Wagner D. β-D-Glucan kinetics for the assessment of treatment response in Pneumocystis jirovecii pneumonia. Clin Microbiol Infect. 2011;17:1118–22.
doi: 10.1111/j.1469-0691.2010.03452.x
pubmed: 21446990
Watanabe T, Yasuoka A, Tanuma J, Yazaki H, Honda H, Tsukada K, et al. Serum (1→3) β-d-glucan as a noninvasive adjunct marker for the diagnosis of pneumocystis pneumonia in patients with AIDS. Clin Infect Dis. 2009;49:1128–31.
doi: 10.1086/605579
pubmed: 19725788
Koga M, Koibuchi T, Kikuchi T, Nakamura H, Miura T, Iwamoto A, et al. Kinetics of Serum. BETA.-D-Glucan after Pneumocystis Pneumonia Treatment in Patients with AIDS. Internal Med. 2011;50:1397–401.
Sims CR, Jaijakul S, Mohr J, Rodriguez J, Finkelman M, Ostrosky-Zeichner L. Correlation of clinical outcomes with β-glucan levels in patients with invasive candidiasis. J Clin Microbiol. 2012;50:2104–6.
doi: 10.1128/JCM.00773-12
pubmed: 22461680
pmcid: 3372136
Träger J, Dräger S, Mihai S, Cipa F, Busse Grawitz A, Epting T, et al. Detailed β-(1→3)-D-glucan and mannan antigen kinetics in patients with candidemia. J Clin Microbiol. 2023;61:e0059823.
doi: 10.1128/jcm.00598-23
pubmed: 37823667
Giacobbe DR, Esteves P, Bruzzi P, Mikulska M, Furfaro E, Mesini A, et al. Initial serum (1,3)-β-d-glucan as a predictor of mortality in proven candidaemia: findings from a retrospective study in two teaching hospitals in Italy and Brazil. Clin Microbiol Infect. 2015;21:954.e9-954.e17.
doi: 10.1016/j.cmi.2015.06.002
pubmed: 26070961
Pini P, Venturelli C, Girardis M, Forghieri F, Blasi E. Prognostic potential of the panfungal marker (1 → 3)-β-D-glucan in invasive mycoses patients. Mycopathologia. 2019;184:147–50.
doi: 10.1007/s11046-018-0282-5
pubmed: 29967970
Bassetti M, Secondary CA, Author C, Bassetti M, Peghin M, Carnelutti A, et al. Intensive care medicine clinical characteristics and predictors of mortality in candidemia and intra-abdominal candidiasis in cirrhotic patients : a multicenter study. 2017. 43(4):509–18.
Fernández J, Piano S, Bartoletti M, Wey EQ. Management of bacterial and fungal infections in cirrhosis: The MDRO challenge. J Hepatol. Elsevier B.V.; 2021. p. S101–17.
Gustot T, Felleiter P, Pickkers P, Sakr Y, Rello J, Velissaris D, et al. Impact of infection on the prognosis of critically ill cirrhotic patients: results from a large worldwide study. Liver Int. 2014;34:1496–503.
doi: 10.1111/liv.12520
pubmed: 24606193
Theocharidou E, Agarwal B, Jeffrey G, Jalan R, Harrison D, Burroughs AK, et al. Early invasive fungal infections and colonization in patients with cirrhosis admitted to the intensive care unit. Clin Microbiol Infect. 2016;22:189.e1-189.e7.
doi: 10.1016/j.cmi.2015.10.020
pubmed: 26551838