Prognostic potential of 1,3-beta-d-glucan levels in bronchoalveolar lavage fluid samples - 24/12/15

Doi : 10.1016/j.jinf.2015.09.016

Frederike M.J. Reischies ^a,^{^{g
These authors contributed equally to this work.}}, Juergen Prattes ^a,^{^{g
These authors contributed equally to this work.}}, Florian Prüller ^b, Susanne Eigl ^c, Agnes List ^d, Albert Wölfler ^d, Walter Buzina ^e, Ines Zollner-Schwetz ^a, Thomas Valentin ^a, Jasmin Rabensteiner ^b, Holger Flick ^c, Robert Krause ^a, Reinhard B. Raggam ^b,^⁎ , Martin Hoenigl ^a,^b,^f,^⁎,^{^{h
Division of Infectious Diseases, Department of Medicine, University of California, San Diego, 200 West Arbor Drive #8208 San Diego, CA 92103, USA. Tel.: +1 6195435605.}}
^a Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
^b Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
^c Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
^d Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
^e Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
^f Division of Infectious Diseases, Department of Medicine, University of California, San Diego, USA

^∗Corresponding author. Section of Infectious Diseases and Tropical Medicine & Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria. Tel.: +43 316 385 81319; fax: +43 316 385 14622.^∗∗Corresponding author. Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria. Tel.: +43 316 385 80243; fax: +43 316 385 14622.

Summary

Objectives

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).

Conclusion

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.

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Keywords : BDG, BAL, Mortality, Survival, Prognostic, 90-Day, 30-Day, ICU

Plan

Introduction

Materials and methods

Results

Patient's characteristics

Candida colonization of the LRT and BALF BDG levels

Prognostic potential of BALF BDG levels

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Vol 72 - N° 1

P. 29-35 - janvier 2016 Retour au numéro

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Prognostic potential of 1,3-beta-d-glucan levels in bronchoalveolar lavage fluid samples - 24/12/15

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