title: Prognostic potential of 1,3-beta-d-glucan levels in bronchoalveolar lavage fluid samples.
abstract: OBJECTIVE
  The objective of this study was to investigate the prognostic potential of 1,3-beta-d-glucan (BDG) testing in bronchoalveolar lavage fluid (BALF) samples.
  
  
  METHODS
  A total of 300 BALF samples from 252 patients were investigated for BDG (Fungitell(®) assay). Prognostic potential of BALF BDG was evaluated by using: i.) Kaplan-Meier analysis, and ii.) multivariable Cox hazard regression analyses.
  
  
  RESULTS
  BALF BDG levels were found to be significantly higher in samples with Candida spp. colonization (p < 0.001). A total of 61/252 patients (24.2%) died within 90-days of BALF sampling (18.1% of patients with BALF BDG <200 pg/mL, 32.4% with BALF BDG ≥200 pg/mL). Kaplan-Meier analysis revealed that overall cumulative 90-day mortality was significantly higher in those with BALF BDG levels ≥200 pg/mL when compared to those with levels <200 pg/mL (log-rank p = 0.006, Breslow p = 0.005 and Tarone-Ware p = 0.005). The multivariable Cox regression analysis showed that BALF BDG levels were a strong predictor of 90-day overall mortality, with a hazard ratio of 1.048 (per 100 pg/mL increase of BALF BDG).
  
  
  CONCLUSIONS
  False positive BALF BDG results in the presence of Candida spp. colonization of the lower respiratory tract may explain the limited diagnostic potential of BALF BDG testing. In contrast, prognostic potential of BALF BDG may be promising.
authors.affiliation: Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Frederike M J
authors.initials: FM
authors.lastname: Reischies
authors.affiliation: Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Juergen
authors.initials: J
authors.lastname: Prattes
authors.affiliation: Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Prüller
authors.affiliation: Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Susanne
authors.initials: S
authors.lastname: Eigl
authors.affiliation: Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Agnes
authors.initials: A
authors.lastname: List
authors.affiliation: Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Albert
authors.initials: A
authors.lastname: Wölfler
authors.affiliation: Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Walter
authors.initials: W
authors.lastname: Buzina
authors.affiliation: Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Ines
authors.initials: I
authors.lastname: Zollner-Schwetz
authors.affiliation: Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Valentin
authors.affiliation: Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
authors.forename: Jasmin
authors.initials: J
authors.lastname: Rabensteiner
authors.affiliation: Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Holger
authors.initials: H
authors.lastname: Flick
authors.affiliation: Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Robert
authors.initials: R
authors.lastname: Krause
authors.affiliation: Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria. Electronic address: reinhard.raggam@medunigraz.at.
authors.forename: Reinhard B
authors.initials: RB
authors.lastname: Raggam
authors.affiliation: Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria; Division of Infectious Diseases, Department of Medicine, University of California, San Diego, USA. Electronic address: martin.hoenigl@medunigraz.at.
authors.forename: Martin
authors.initials: M
authors.lastname: Hoenigl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D058365:Candidiasis, Invasive / Q000175:diagnosis* / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D055732:Pulmonary Aspergillosis / Q000175:diagnosis* / Q000401:mortality*; D012307:Risk Factors; D055815:Young Adult; D047071:beta-Glucans / Q000032:analysis*
chemical_list: D047071:beta-Glucans
keywords: 30-Day; 90-Day; BAL; BDG; ICU; Mortality; Prognostic; Survival