title: Evaluation of serum (1 → 3)-β-D-glucan clinical performance: kinetic assessment, comparison with galactomannan and evaluation of confounding factors.
abstract: OBJECTIVE
  We investigated the clinical performance of (1 → 3)-β-D-glucan (BG), as an early marker of invasive fungal infections (IFI), in different clinical settings.
  
  
  METHODS
  BG serum levels were assessed by Fungitell (Associates of Cape Cod, Inc), in parallel with galactomannan (GM) when requested by clinicians. By a prospective monocentric study, 270 episodes at risk or with suspect of IFI were enrolled, namely 58 proven-probable invasive aspergillosis (IA), 27 proven invasive candidiasis (IC), 11 possible IC, 16 P.jirovecii pneumonia (PJP), 4 episodes of other IFI and 154 non-IFI controls.
  
  
  RESULTS
  We found that (a) the BG overall sensitivity, specificity, positive predictive value and negative predictive value (NPV) were 87.9, 80.5, 76.7 and 89.9 %, respectively; (b) the highest sensitivity was found in the IC groups, followed by PJP, IA and other IFI groups; (c) an association was observed between BG kinetics and patients outcome; (d) in the IA episodes, the combination of BG or GM vs GM alone increased sensitivity from 60.0 to 83.3 % in the haematological patients; (e) false-positive BG results were related to Gram-negative infections or infusion of polyclonal IgM-enriched immunoglobulins, where high levels of BG were indeed detected.
  
  
  CONCLUSIONS
  Besides strengthening its overall good clinical performance, we provide evidence that serum BG correlates with clinical outcome and that, once used in combination with GM, BG allows to enhance IFI diagnosis rate. The high sensitivity and NPV, observed in the Intensive Care Unit setting, open to BG validation as a marker for assessment of antifungal treatment.
authors.affiliation: Dipartimento Interaziendale Integrato di Medicina di Laboratorio e Anatomia Patologica, Struttura Complessa di Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.|Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Pini
authors.affiliation: Dipartimento Interaziendale Integrato di Medicina di Laboratorio e Anatomia Patologica, Struttura Complessa di Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Bettua
authors.affiliation: Dipartimento di Medicina Diagnostica, Clinica e di Sanità Pubblica, Istituti Biologici, Università di Modena e Reggio Emilia, Via Campi 287, 41125, Modena, Italy.|Dipartimento di Scienze della Salute, Università di Milano, Polo Universitario San Paolo, Milan, Italy.
authors.forename: C F
authors.initials: CF
authors.lastname: Orsi
authors.affiliation: Dipartimento Interaziendale Integrato di Medicina di Laboratorio e Anatomia Patologica, Struttura Complessa di Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Venturelli
authors.affiliation: Dipartimento Attività Integrata di Oncologia, Ematologia e Patologie dell'Apparato Respiratorio, Ematologia, Azienda Ospedaliero-Universitaria Policlinico, Università di Modena e Reggio Emilia, Modena, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Forghieri
authors.affiliation: Dipartimento Attività Integrata di Oncologia, Ematologia e Patologie dell'Apparato Respiratorio, Ematologia, Azienda Ospedaliero-Universitaria Policlinico, Università di Modena e Reggio Emilia, Modena, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bigliardi
authors.affiliation: Dipartimento Attività Integrata di Oncologia, Ematologia e Patologie dell'Apparato Respiratorio, Ematologia, Azienda Ospedaliero-Universitaria Policlinico, Università di Modena e Reggio Emilia, Modena, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Faglioni
authors.affiliation: Dipartimento Attività Integrata di Oncologia, Ematologia e Patologie dell'Apparato Respiratorio, Malattie dell'Apparato Respiratorio, Università di Modena e Reggio Emilia, Modena, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Luppi
authors.affiliation: Divisione di Anestesiologia e Terapia Intensiva, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Serio
authors.affiliation: Dipartimento Attività Integrata di Medicine, Medicina d'Urgenza e Specialità Mediche, Malattie infettive, Università di Modena e Reggio Emilia, Modena, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Codeluppi
authors.affiliation: Dipartimento Attività Integrata di Oncologia, Ematologia e Patologie dell'Apparato Respiratorio, Ematologia, Azienda Ospedaliero-Universitaria Policlinico, Università di Modena e Reggio Emilia, Modena, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Luppi
authors.affiliation: Dipartimento Attività Integrata di Medicine, Medicina d'Urgenza e Specialità Mediche, Malattie infettive, Università di Modena e Reggio Emilia, Modena, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Mussini
authors.affiliation: Divisione di Anestesiologia e Terapia Intensiva, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Girardis
authors.affiliation: Dipartimento di Medicina Diagnostica, Clinica e di Sanità Pubblica, Istituti Biologici, Università di Modena e Reggio Emilia, Via Campi 287, 41125, Modena, Italy. elisabetta.blasi@unimore.it.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Blasi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000946:Antigens, Fungal / Q000097:blood*; D005260:Female; D016469:Fungemia / Q000175:diagnosis*; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D008297:Male; D008351:Mannans / Q000097:blood*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011509:Proteoglycans; D012680:Sensitivity and Specificity; D044967:Serum / Q000737:chemistry*; D055815:Young Adult; D047071:beta-Glucans / Q000097:blood*
chemical_list: D000946:Antigens, Fungal; D008351:Mannans; D011509:Proteoglycans; D047071:beta-Glucans; C012990:galactomannan; C010770:polysaccharide-K; D005690:Galactose
keywords: (1 → 3)-β-D-glucan; Galactomannan; Invasive fungal infections (IFI); Kinetics; Performance