Usage of 1,3-β-D-Glucan for Early Detection of Invasive Mycoses and Outcome Parameter in Immunocompromised Critically Ill Patients.
BACKGROUND
Invasive fungal disease (IFD) remains a significant cause of morbidity and mortality in critically ill patients.


METHODS
Examination of 1,3-β-D-glucan (BDG) for IFD and as outcome parameter in immunocompromised critically ill patients with septic shock.


RESULTS
Thirty-two (69 %) out of 46 included patients had BDG beyond the cutoff of >80 pg/ml (mean 320 pg/ml). Twelve (37 %) had findings of Aspergillus spp. in BAL (mean BDG 413 pg/ml). EORTC/MSG guidelines classified these as probable invasive aspergillosis (IA)/IFD. Five (16 %) had candidaemia (mean BDG level 361 pg/ml). Sensitivity of 78 % (95 % CI 58-88 %) and specificity of 68 % (95 % CI 52-77 %) for IFD were found on the BDG Fungitell assay. In detail, a sensitivity of 73 % (95 % 58-84 %) and specificity of 83 % (95 % CI 68-93 %) for IA and a sensitivity of 77 % (CI 95 % 62-87 %) and specificity 53 % (95 % CI 37-73 %) for candidaemia were found. APACHE II, SOFA score and mortality rate were in the elevated BDG group significantly altered (26 vs. 21, p < 0.003; 15 vs. 13, p < 0.006; 72 vs. 50 %, p < 0.004).


CONCLUSIONS
1,3-β-D-glucan assay is helpful for early detection of IFD; moreover, elevated BDG levels can be used as a predictor for outcome in immunocompromised critically ill patients as presented in our study.
II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, Munich, Germany. TobiasLahmer@me.com.
Tobias
T
Lahmer
Mikrobiologisches Institut, Universitätsklinik Erlangen und Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany.
Jürgen
J
Held
II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
Sebastian
S
Rasch
II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
Christopher
C
Schnappauf
II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
Analena
A
Beitz
II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
Roland M
RM
Schmid
II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
Wolfgang
W
Huber
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D003955:Diagnostic Tests, Routine / Q000379:methods*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D000072742:Invasive Fungal Infections / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011509:Proteoglycans; D012680:Sensitivity and Specificity; D012772:Shock, Septic / Q000175:diagnosis*; D016896:Treatment Outcome; D055815:Young Adult; D047071:beta-Glucans / Q000097:blood*
D011509:Proteoglycans; D047071:beta-Glucans; C010770:polysaccharide-K
1,3-β-D-glucan; Critically ill; Immunosuppression; Septic shock