title: Serum galactomannan index for early prediction of mortality in immunocompromised children with invasive pulmonary aspergillosis.
abstract: BACKGROUND
  Invasive pulmonary aspergillosis (IPA) is the most common invasive fungal disease in immunocompromised patients, and it has a 30 % mortality rate despite appropriate antifungal therapy. This retrospective study was performed to determine risk factors for mortality in immunocompromised children with IPA.
  
  
  METHODS
  Medical records of 45 probable/proven IPA cases diagnosed in children with hematologic/oncologic diseases were reviewed. Selected cases were divided into the survival (n = 30) and fatality (n = 15) groups based on survival at 12 weeks after antifungal therapy. Clinical characteristics and serum galactomannan indices (GMIs) were compared between the two groups.
  
  
  RESULTS
  Significantly more children in the fatality group were male (p = 0.044), not in complete remission of the underlying malignancies (p = 0.016), and had received re-induction/salvage or palliative chemotherapy (p = 0.035) than those in the survival group. However, none of these factors was significantly associated with mortality in a multivariate analysis. Serum GMIs were higher in the fatality group than in the survival group during the entire period of antifungal therapy, and serum GMI at 1 week after antifungal therapy was most significantly associated with mortality. A serum GMI > 1.50 at 1 week after antifungal therapy exhibited a sensitivity and specificity of 61.5 % and 89.3 %, respectively, in predicting mortality within 12 weeks after antifungal therapy.
  
  
  CONCLUSIONS
  Higher serum GMI in the early phase of antifungal therapy was associated with mortality in immunocompromised children with IPA. These children should receive more intensive care for IPA than others.
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. beomsid@catholic.ac.kr.|The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. beomsid@catholic.ac.kr.
authors.forename: Seung Beom
authors.initials: SB
authors.lastname: Han
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. ksk3497@catholic.ac.kr.|The Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. ksk3497@catholic.ac.kr.
authors.forename: Seong Koo
authors.initials: SK
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. dashwood@catholic.ac.kr.|The Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. dashwood@catholic.ac.kr.
authors.forename: Jae Wook
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. pedjsyoon@catholic.ac.kr.|The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. pedjsyoon@catholic.ac.kr.
authors.forename: Jong-Seo
authors.initials: JS
authors.lastname: Yoon
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. cngped@catholic.ac.kr.|The Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. cngped@catholic.ac.kr.
authors.forename: Nack-Gyun
authors.initials: NG
authors.lastname: Chung
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. chobinkr@catholic.ac.kr.|The Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. chobinkr@catholic.ac.kr.|Department of Pediatrics, Seoul St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea. chobinkr@catholic.ac.kr.
authors.forename: Bin
authors.initials: B
authors.lastname: Cho
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. dcjeong@catholic.ac.kr.
authors.forename: Dae Chul
authors.initials: DC
authors.lastname: Jeong
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. kjhan@catholic.ac.kr.|The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. kjhan@catholic.ac.kr.
authors.forename: Jin Han
authors.initials: JH
authors.lastname: Kang
authors.affiliation: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. kimhk@catholic.ac.kr.|The Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. kimhk@catholic.ac.kr.
authors.forename: Hack-Ki
authors.initials: HK
authors.lastname: Kim
authors.affiliation: The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. symonlee@catholic.ac.kr.|The Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. symonlee@catholic.ac.kr.|Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. symonlee@catholic.ac.kr.
authors.forename: Dong-Gun
authors.initials: DG
authors.lastname: Lee
authors.affiliation: Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 2reality@hanmail.net.
authors.forename: Hyun Sil
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. sooahim@daum.net.
authors.forename: Soo Ah
authors.initials: SA
authors.lastname: Im
mesh_terms: D000293:Adolescent; D000935:Antifungal Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D055744:Invasive Pulmonary Aspergillosis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D008351:Mannans / Q000097:blood*; D008499:Medical Records; D056910:Republic of Korea; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D000935:Antifungal Agents; D008351:Mannans; C012990:galactomannan; D005690:Galactose