Prognostic value of serum galactomannan in mixed ICU patients: a retrospective observational study (original) (raw)
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PloS one, 2018
This study was conducted to get a complete clinical and mycological picture of invasive aspergillosis (IA) in respiratory medicine ICU of a tertiary care hospital. From the cohort of 235 patients only one had proven IA. Based on AspICU algorithm, 21 had putative IA (8.9%), 12 were colonised (5.1%). Adjusting the confounding factors, significant risk factors for IA were chronic obstructive pulmonary disease (COPD), temperature of ≥38°C, pneumonia and acute respiratory distress syndrome (ARDS). The best predictor of IA was AspICU algorithm (AUC, 1) followed by serum galactomannan antigen (GM) cut-off (≥1.24) calculated based on AspICU algorithm (AUC, 0.822). For 37% of patients, IA diagnoses was made earlier with serum GM than radiology. There were 70/235 (29.8%) deaths within 30 days of enrolment in the study. Aspergillus culture positivity (34/235, 14.5%) was associated with very high mortality (27/34, 79.4%), (p<0.05). The best predictor of mortality was GM cut-off (≥1.24) calcu...
Clinical Microbiology and Infection, 2011
Diagnosis of fungal pneumonia (FP) in critically ill patients is challenging. Circulating biomarkers for the diagnosis of FP have limitations and the combination of different assays in serum samples and directly from the target organ may further improve the diagnosis of FP. We prospectively assessed the diagnostic utility of paired galactomannan (GM) in bronchoalveolar lavage fluid (BAL) and serum GM and (1fi3)-b-D-glucan (BG) assays in critically ill patients at risk of FP. Patients with FP were classified according to European Organisation for Research and Treatment of Cancer-Mycoses Study Group criteria, with modifications. Out of 847 admissions, 51 patients were eligible. There were nine invasive aspergillosis (IA) cases (four proven, five probable), three proven Pneumocysitis jirovecii pneumonia (PJP) cases and one mixed FP case (probable IA and proven PJP). The diagnostic accuracy as given by the area under the receiver operating characteristic curve in IA cases (proven and probable) for GM in BAL was 0.98 (95% CI, 0.94-1.00), whilst for GM and BG in serum it was 0.85 (95% CI, 0.74-0.96) and 0.815 (95% CI, 0.66-0.96), respectively. For IA cases (proven and probable) AUC for GM in BAL was significantly higher than GM and BG in serum (p 0.025 and p 0.032, respectively). In one of four proven and one of six probable IA cases, GM in serum remained negative, whereas GM in BAL was positive. In patients with IA, GM (90%) and BG (80%) appeared a mean of 4.3 days (range, 1-10 days) before Aspergillus was cultured. GM detection in BAL appears to improve the diagnosis of IA in critical patients.
Critical care (London, England), 2016
An algorithm for distinguishing invasive pulmonary aspergillosis (IPA) in critically ill patients (AspICU) has been proposed but not tested. This was a prospective observational study applying the AspICU protocol to patients with positive Aspergillus culture (PAC group) and those with negative aspergillus culture but positive galactomannan test in respiratory tract samples (only positive galactomannan (OPG group)). Patients underwent a standardized diagnostic workup with bronchoscopy, computed tomography (CT), and galactomannan determination in serum and bronchoalveolar lavage fluid (BALF). We included 85 patients in the study. Of these, 43 had positive aspergillus cultures and 42 patients had only a positive galactomannan test. There were no statistically significant differences in baseline characteristics, underlying conditions or ICU scores between the two groups. The galactomannan titre in BALF was significantly higher in the positive aspergillus culture (PAC) group (enzyme immu...
Serum galactomannan levels in the diagnosis of invasive aspergillosis
The Korean Journal of Internal Medicine, 2015
Background/Aims: In this study, the sensitivity-specificity of galactomannan-enzyme immunoassay (GM-EIA) with a cutoff value of 0.5 for a single, two, or three consecutive positivity in the diagnosis of invasive pulmonary aspergillosis (IPA) in neutropenic patients with hematological malignancy was investigated. Methods: IPA was classified as "proven," "probable," or "possible" as described in the guidelines prepared by the European Organization for Research and Treatment of Cancer and Mycoses Study Group." Serum samples were collected from the patients twice a week throughout their hospitalization. A total of 1,385 serum samples, with an average of 8.3 samples per episode, were examined. Results: Based on the 165 febrile episodes in 106 patients, 80 (48.5%) were classified as IPA (4 proven, 11 probable, 65 possible) and 85 (51.5%) as non-IPA. The sensitivity/specificity was 100%/27.1% for a single proven/probable IPA with the cut of value of GM-EIA ≥ 0.5, 86.7%/71.8% for two consecutive positive results, and 73.3%/85.9% for three consecutive positive results. Conclusions: With the galactomannan levels measured twice a week, consecutive sensitivity decreased and specificity increased. Therefore, an increase may be obtained in sensitivity-specificity by more frequent monitoring of GM-EIA starting from the first day of positivity is detected.
https://www.ijhsr.org/IJHSR\_Vol.10\_Issue.1\_Jan2020/IJHSR\_Abstract.025.html, 2020
Introduction: Invasive fungal infections (IFI) are one of the major life threatening infections in patients of acute leukemias including those undergoing haematopoietic stem cell transplantation, of which candida and aspergillus are chief fungal pathogens. In most of the cases antifungal treatment is started empirically, due to lack of specific clinical radiological, and laboratory features, which has a mortality benefit but at the cost of overuse of antifungals in more than 50% of high risk patients, though incidence of IFI is only around 10%. Aim & Objectives: Use of Galactomannan Enzyme Immunoassay for the diagnosis and monitoring of Invasive Aspergillosis in patients of Acute leukemia and Allogenic Hematopoietic Stem Cell Transplantation. Materials & Methods: Serum Galactomannan levels of 100 patients who have received chemotherapy for acute leukemia or myelodysplastic syndrome or those who have undergone a myeloablative HSCT, were prospectively monitored for 16 weeks. These results were compared with probability of having invasive aspergillosis (IA) at any time during induction chemotherapy or allogenic stem cell transplantation as per EORTC/MSG criteria. Results: Thirteen patients had proven IA whereas, 45 patients had probable or possible IA and 42 patients had no evidence of IA as per EORTC/MSG criteria. Mycological evidence of aspergillosis was obtained in 32 patients whereas CT chest & PNS at any time point showed evidence of aspergillosis in 34 out of 100 patients. Serum Galactomannan index at any time point was positive in 39 patients by taking cut-off of 0.5. S. Galactomannan was found to be positive earlier than CT positivity for IA (9 vs 14 days). Nineteen patients had persistent positive Galactomannan index. Sensitivity and specificity of S.Galactomannan for diagnosing IA was 75% & 83.3% respectively on day +1 of fever and 78.6% & 84.7% respectively on day +4 of fever. There was significant correlation between absolute neutrophil count and GM index. Conclusion: Galactomannan index is an early predictor of invasive aspergillosis which was found to be positive earlier than CT positivity. Besides being a diagnostic marker of IA, serum GM can also be used to monitor response to therapy. However further studies are required to validate the hypothesis.
Journal of clinical microbiology, 1999
Efforts to improve the diagnosis of invasive aspergillosis (IA) have been directed towards the detection of fungal antigens, including galactomannan (GM). However, previous evaluations of GM detection have been hampered by a lack of proven cases of IA and by a nonserial study design. This prospective study assessed the diagnostic value of serial screening for circulating GM by using a recently developed sandwich enzyme-linked immunosorbent assay (ELISA) for prolonged-neutropenic and/or steroid-treated patients with hematological disorders. Serum GM levels were monitored twice weekly for 186 consecutive patients at increased risk for IA. The patients were stratified according to the likelihood of IA (proven, probable, possible, and no evidence of IA) by using stringent criteria. Proven IA was defined by characteristic histopathological findings together with a positive culture for Aspergillus species. Autopsy and culture from autopsy specimens was used to verify both positive and neg...
Clinical Microbiology and Infection, 2009
The detection of circulating galactomannan (GM) in serum samples is an important step in the diagnosis of invasive aspergillosis (IA). The assay has been mainly explored in neutropenic patients, and is now used to monitor patients at high risk for IA. However, the performance of the assay varies greatly among studies. The objective of this study was to explore the impact of the neutrophil count on the GM serum index at the time of IA diagnosis. Ninety-nine episodes of proven or probable, microbiologically documented IA in 91 patients with haematological malignancies were studied retrospectively. Three groups were identified: groups 1-3, with <100 polymorphonuclear neutrophils (PMN)/mm 3 (n = 18), between 100 and 500 PMN/mm 3 (n = 21), or >500 PMN/mm 3 (n = 60), respectively. The mean GM index was significantly higher in group 1 than in the other groups (p <0.05). This finding did not change after stratifying the analysis with regard to the use of antibiotics likely to give false-positive GM results or with regard to treatment effective against fungi before the diagnosis of IA. This finding could be considered in the routine use of the GM antigenaemia test in non-neutropenic patients; a negative result or a low GM index should not eliminate the diagnosis of IA. This limitation calls for other microbiological tests, including analysis of bronchoalveolar lavage fluid, to establish a definitive diagnosis of IA.
Acta Haematologica
Introduction: Invasive aspergillosis (IA) affects mainly patients with hematological malignancies, and early diagnosis is crucial for timely treatment. Most diagnoses are based on clinical and mycological criteria, mostly galactomannan (GM) test in serum or bronchoalveolar fluid, which is performed in case of clinical suspicion or as routine screening in patients at high risk who are not receiving anti-mold prophylaxis, for early detection of IA. The aim of this study was to assess in a real-world setting the efficacy of biweekly serum GM screening for the early detection of IA. Methods: A retrospective cohort that included 80 adult patients treated at the Hematology Department, Hadassah Medical Center, 2016–2020, with a diagnosis of IA. Clinical and laboratory data were collected from patients’ medical files and the rate of GM-driven, GM-associated, and non-GM-associated IA was calculated. Results: There were 58 patients with IA. The rate of GM-driven diagnosis was 6.9%, GM-associa...