title: (1, 3)-β-D-glucan assay for diagnosing invasive fungal infections in critically ill patients with hematological malignancies.
abstract: Invasive fungal infections (IFIs) are life-threatening complications of hematological malignancies that must be diagnosed early to allow effective treatment. Few data are available on the performance of serum (1-3)-β-D-glucan (BG) assays for diagnosing IFI in patients with hematological malignancies admitted to the intensive care unit (ICU). In this study, 737 consecutive patients with hematological malignancies admitted to 17 ICUs routinely underwent a BG assay at ICU admission. IFIs were diagnosed using standard criteria applied by three independent specialists. Among the 737 patients, 439 (60%) required mechanical ventilation and 273 (37%) died before hospital discharge. Factors known to alter BG concentrations were identified in most patients. IFIs were documented in 78 (10.6%) patients (invasive pulmonary aspergillosis, n = 54; Pneumocystis jirovecii pneumonia, n = 13; candidemia, n = 13; and fusarium infections, n = 3). BG concentrations (pg/mL) were higher in patients with than without IFI (144 (77-510) vs. 50 (30-125), < 0.0001). With 80 pg/mL as the cutoff, sensitivity was 72%, specificity 65%, and area-under-the-curve 0.74 (0.68-0.79). Assuming a prevalence of 10%, the negative and positive predictive values were 94% and 21%. By multivariable analysis, factors independently associated with BG > 80 pg/mL were IFI, admission SOFA score, autologous bone-marrow or hematopoietic stem-cell transplantation, and microbiologically documented bacterial infection. In conclusion, in unselected critically ill hematology patients with factors known to affect serum BG, this biomarker showed only moderate diagnostic performance and rarely detected IFI. However, the negative predictive value was high. Studies are needed to assess whether a negative BG test indicates that antifungal de-escalation is safe.
authors.affiliation: Medical ICU and Mycology Department, Saint-Louis Hospital, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.affiliation: Medical ICU and Mycology Department, Saint-Louis Hospital, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Guigue
authors.affiliation: Medical-Surgical ICU, Saint-Etienne University Hospital, Saint-Étienne, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Darmon
authors.affiliation: Medical-Surgical ICU Paoli Calmette Cancer Institute, Marseille, France.
authors.forename: Djamel
authors.initials: D
authors.lastname: Mokart
authors.affiliation: Medical ICU and Mycology Department, Saint-Louis Hospital, Paris, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lemiale
authors.affiliation: Medical ICU, Angers University Hospital, Angers, France.
authors.forename: Achille
authors.initials: A
authors.lastname: Kouatchet
authors.affiliation: Medical ICU CHU Pitié-Salpêtrière, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Mayaux
authors.affiliation: Medical-Surgical ICU, Montfermeil Hospital, Montfermeil, France.
authors.forename: François
authors.initials: F
authors.lastname: Vincent
authors.affiliation: Medical ICU and Mycology Department, Saint-Louis Hospital, Paris, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Nyunga
authors.affiliation: Medical ICU and Mycology Department, Saint-Louis Hospital, Paris, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bruneel
authors.affiliation: Medical ICU and Pulmonary Department, Cochin Hospital, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Rabbat
authors.affiliation: Medical ICU and Mycology Department, Saint-Louis Hospital, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bretagne
authors.affiliation: Medical-Surgical ICU, La Roche Sur Yon Hospital, La Roche Sur Yon, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Lebert
authors.affiliation: Medical-Surgical ICU, Jules Bordet Cancer Institute, Brussels, Belgium.
authors.forename: Anne-Pascale
authors.initials: AP
authors.lastname: Meert
authors.affiliation: Medical-Surgical ICU, Ghent University Hospital, Gent, Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Benoit
authors.affiliation: Medical ICU and Pulmonary Department, Cochin Hospital, Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pene
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D000072742:Invasive Fungal Infections / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011509:Proteoglycans; D012680:Sensitivity and Specificity; D047071:beta-Glucans / Q000097:blood*
chemical_list: D015415:Biomarkers; D011509:Proteoglycans; D047071:beta-Glucans; C010770:polysaccharide-K
keywords: (1–3)-beta-D-glucan assay; diagnostic tests; intensive care units; invasive fungal infection