title: Strong correlation between serum aspergillus galactomannan index and outcome of aspergillosis in patients with hematological cancer: clinical and research implications.
abstract: BACKGROUND
  Galactomannan is an Aspergillus-specific polysaccharide released during aspergillosis and is detected by the quantitative serum galactomannan index (GMI) test. Preclinical and preliminary clinical reports have suggested a good correlation between GMI and aspergillosis outcome.
  
  
  METHODS
  We reviewed the literature to assess the strength of correlation between GMI and aspergillosis outcome using the kappa correlation coefficient. We included 27 studies that enrolled patients with hematological cancer and proven or probable aspergillosis and that used sequential GMI testing. We examined the 3 following outcomes: survival (survival vs. death), global outcome (survival vs. death [including autopsy findings]), and autopsy outcome (autopsy findings only).
  
  
  RESULTS
  Overall, 257 patients fulfilled criteria for proven or probable aspergillosis and were eligible for outcome evaluation. Correlation between GMI (within <or=1 week before outcome) and defined outcomes was excellent, with kappa correlation coefficients of 0.8737 (95% confidence interval, 0.8140-0.9333; P<.001) and 0.9123 (95% confidence interval, 0.8617-0.9629; P<.001) for survival and global outcome, respectively. Most importantly, the kappa correlation coefficient for autopsy outcome was high (0.8498; 95% confidence interval, 0.5608-1.000; P<.001). Furthermore, the kappa correlation coefficient for all outcomes was comparable across age groups (pediatric and adult patients) and treatment modalities, including allogeneic transplantation. This strong correlation is also supported by extensive preclinical data and recent clinical reports.
  
  
  CONCLUSIONS
  We conclude that serum GMI is a good marker of aspergillosis outcome.
authors.affiliation: Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
authors.forename: Marisa H
authors.initials: MH
authors.lastname: Miceli
authors.forename: Monica L
authors.initials: ML
authors.lastname: Grazziutti
authors.forename: Gail
authors.initials: G
authors.lastname: Woods
authors.forename: Weizhi
authors.initials: W
authors.lastname: Zhao
authors.forename: Mehmet H
authors.initials: MH
authors.lastname: Kocoglu
authors.forename: Bart
authors.initials: B
authors.lastname: Barlogie
authors.forename: Elias
authors.initials: E
authors.lastname: Anaissie
mesh_terms: D001228:Aspergillosis / Q000097:blood / Q000150:complications / Q000473:pathology*; D001230:Aspergillus / Q000187:drug effects / Q000378:metabolism*; D005690:Galactose / Q000031:analogs & derivatives; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008351:Mannans / Q000097:blood*; D015201:Meta-Analysis as Topic; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D008351:Mannans; C012990:galactomannan; D005690:Galactose