title: Measuring (1,3)-β-D-glucan in tracheal aspirate, bronchoalveolar lavage fluid, and serum for detection of suspected Candida pneumonia in immunocompromised and critically ill patients: a prospective observational study.
abstract: While Candida pneumonia is life-threatening, biomarker measurements to early detect suspected Candida pneumonia are lacking. This study compared the diagnostic values of measuring levels of (1, 3)-β-D-glucan in endotracheal aspirate, bronchoalveolar lavage fluid, and serum to detect suspected Candida pneumonia in immunocompromised and critically ill patients.
  
  
  
  This prospective, observational study enrolled immunocompromised, critically ill, and ventilated patients with suspected fungal pneumonia in mixed intensive care units from November 2010 to October 2011. Patients with D-glucan confounding factors or other fungal infection were excluded. Endotracheal aspirate, bronchoalveolar lavage fluid and serum were collected from each patient to perform a fungal smear, culture, and D-glucan assay.
  
  
  
  After screening 166 patients, 31 patients completed the study and were categorized into non-Candida pneumonia/non-candidemia (n = 18), suspected Candida pneumonia (n = 9), and non-Candida pneumonia/candidemia groups (n = 4). D-glucan levels in endotracheal aspirate or bronchoalveolar lavage were highest in suspected Candida pneumonia, while the serum D-glucan level was highest in non-Candida pneumonia/candidemia. In all patients, the D-glucan value in endotracheal aspirate was positively correlated with that in bronchoalveolar lavage fluid. For the detection of suspected Candida pneumonia, the predictive performance (sensitivity/specificity/D-glucan cutoff [pg/ml]) of D-glucan in endotracheal aspirate and bronchoalveolar lavage fluid was 67%/82%/120 and 89%/86%/130, respectively, accounting for areas under the receiver operating characteristic curve of 0.833 and 0.939 (both P < 0.05), respectively. Measuring serum D-glucan was of no diagnostic value (area under curve =0.510, P = 0.931) for the detection of suspected Candida pneumonia in the absence of concurrent candidemia.
  
  
  
  D-glucan levels in both endotracheal aspirate and bronchoalveolar lavage, but not in serum, provide good diagnostic values to detect suspected Candida pneumonia and to serve as potential biomarkers for early detection in this patient population.
authors.affiliation: Department of Chest Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou Dist., Taipei City, 11217, Taiwan, Republic of China.|Center of Sleep Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou Dist., Taipei City, 11217, Taiwan, Republic of China.|Institute of Physiology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong St., Beitou Dist., Taipei City, 11221, Taiwan, Republic of China.
authors.forename: Kang-Cheng
authors.initials: KC
authors.lastname: Su
authors.affiliation: Department of Chest Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou Dist., Taipei City, 11217, Taiwan, Republic of China.|Center of Sleep Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou Dist., Taipei City, 11217, Taiwan, Republic of China.
authors.forename: Kun-Ta
authors.initials: KT
authors.lastname: Chou
authors.affiliation: Department of Chest Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou Dist., Taipei City, 11217, Taiwan, Republic of China.|Institute of Physiology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong St., Beitou Dist., Taipei City, 11221, Taiwan, Republic of China.
authors.forename: Yi-Han
authors.initials: YH
authors.lastname: Hsiao
authors.affiliation: Institute of Physiology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong St., Beitou Dist., Taipei City, 11221, Taiwan, Republic of China.|Division of Thoracic Medicine, Department of Medicine, Cheng Hsin General Hospital, No.45, Cheng Hsin St., Beitou Dist., Taipei City, 11220, Taiwan, Republic of China.
authors.forename: Ching-Min
authors.initials: CM
authors.lastname: Tseng
authors.affiliation: Department of Chest Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou Dist., Taipei City, 11217, Taiwan, Republic of China.
authors.forename: Vincent Yi-Fong
authors.initials: VY
authors.lastname: Su
authors.affiliation: Sijhih Cathay General Hospital, No.2, Ln. 59, Jiancheng Rd., Xizhi Dist., New Taipei City, 22174, Taiwan, Republic of China.
authors.forename: Yu-Chin
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Department of Chest Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou Dist., Taipei City, 11217, Taiwan, Republic of China. dwperng@vghtpe.gov.tw.|School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong St., Beitou Dist., Taipei City, 11221, Taiwan, Republic of China. dwperng@vghtpe.gov.tw.
authors.forename: Diahn-Warng
authors.initials: DW
authors.lastname: Perng
authors.affiliation: Institute of Physiology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong St., Beitou Dist., Taipei City, 11221, Taiwan, Republic of China. yrkou@ym.edu.tw.
authors.forename: Yu Ru
authors.initials: YR
authors.lastname: Kou
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D001992:Bronchoalveolar Lavage Fluid; D058387:Candidemia / Q000175:diagnosis; D002177:Candidiasis / Q000175:diagnosis*; D016638:Critical Illness; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000382:microbiology; D011446:Prospective Studies; D011509:Proteoglycans; D012680:Sensitivity and Specificity; D047071:beta-Glucans / Q000032:analysis*
chemical_list: D015415:Biomarkers; D011509:Proteoglycans; D047071:beta-Glucans; C010770:polysaccharide-K
keywords: (1,3)-β-D-glucan; Bronchoalveolar lavage; Candida pneumonia; Critically ill patients; Diagnosis; Intensive care unit