ABSTRACT
Objective To evaluate the detection value of serum (1,3)-β-D glucan (G-test) and galactomannan (GM-test) combined with sputum fungal culture in the early diagnosis of invasive fungal infection(IFI) in intensive care unit(ICU) patients.Methods Inpatients with high risk factors for IFI in the ICU of the Affiliated Hospital of Xuzhou Medical University between January 2015 and December 2016 were chosen,they were divided into 3 groups according to the diagnostic criteria of IFI:IFI group(including confirmed and clinically diagnosed cases),suspected IFI group,and non-IFI group.The results of serum G-test,GM-test,and sputum fungal culture in three groups of patients were analyzed,early diagnostic value in IFI with combined three tests was evaluated.Results A total of 264 ICU patients were investigated,IFI group,suspected IFI group,and non-IFI group were 56,43,and 165 cases respectively.Among 56 cases of confirmed IFI,46,39,and 34 were positive for G-test,GM-test,and fungal culture respectively.The sensitivity,specificity,positive predictive value,and negative predictive value of combined three detection were 98.2％,82.4％,65.5％,and 99.3％ respectively,positive likelihood ratio,negative likelihood ratio,and Youden index were 5.58,0.02,and 0.98 respectively.The sensitivity and negative predictive values of combined three detection were both higher than those of single G-test,GM-test,and sputum fungal culture (all P＜0.05);but specificity and positive predictive value of combined three detection were not significantly different from single G-test,GM-test,and sputum fungal culture(all P＞0.05).Conclusion The combination of G-test,GM-tests,and sputum fungal culture can improve the sensitivity of early diagnosis of IFI in ICU patients,and guide the clinicians in the early treatment of IFI.
ABSTRACT
Objective To evaluate the diagnostic efficiency of deep fungal infection by detecting the serum galactomannan ( GM) and bronchoalveolar lavage fluid ( BALF) GM, serum G test and fungal culture of BALF in patients with suspected invasive fungal infection ( IFI) in lungs.Methods A retrospective analysis was performed of the results of serum /BALF GM test ,serum G test and BALF culture from 148 patients with suspected pulmonary IFI .The indexes involved sensitivity , specificity , positive predictive value , negative predictive value , as well as diagnostic capacity for deep fungal infection with separated or combined tests .Results Among the 148 cases, 48 cases were clinically diagnosed with IFI and the rest were excluded.Among the 48 IFI cases, 3 cases were positive in serum GM test , 25 cases were positive in BALF GM test , 31 cases were positive in G test and 30 cases were positive in fungal culture .The combined detection showed a sensitivity of 91.6%,specificity of 70.0%, positive predictive value of 59.5% and negative predictive value of 94.6%.Conclusion The combination of GM/G tests and fungal culture can significantly improve the clinical diagnostic efficiency of pulmonary IFI .
ABSTRACT
ObjectiveTo explore the diagnostic value of plasma (1, 3)-β-D-glucan test (G test) in diagnosis of invasive fungal infections (IFI) and the influence of albumin on G test.Methods A prospective observational study was conducted. 267 patients admitted to medical intensive care unit (MICU) of Dalian Municipal Central Hospital from January 21st, 2012 to October 31st, 2014 were enrolled. According to IFI guideline, the patients were divided into without IFI group (n= 35), possible IFI group (n = 70), hypotheticle IFI group (n = 145) and proven IFI group (n = 17). G test was examined routinely using microbiology kinetic rapid reader MB-80.The different threshold values were calculated on G test. The difference among G tests, fungal culture and clinical diagnosis were compared. The results of G test ahead of and post albumin administration in each group were compared, and the value of G test for diagnosis of IFI during albumin infusion was evaluated.Results When the cut-off value was 20 ng/L for IFI diagnosis, higher sensitivity (79.8%), specificity (87.9%), and Youden index (67.7%) were found. The positive rates of G test, fungal culture and clinical diagnosis of IFI were 57.7% (154/267), 60.7% (162/267) and 54.3%(145/267) respectively, without showing significant differences (allP> 0.05). The result of G test (ng/L) was not obviously changed after albumin administration compared with that before in without IFI, possible IFI, hypotheticle IFI, and proven IFI groups (without IFI group: 11.25±2.33 vs. 10.99±1.07,t= -1.723,P= 0.085; possible IFI group: 53.14±5.53 vs. 49.22±8.11,t= -0.395,P= 0.693; hypotheticle IFI group: 90.30±9.38 vs. 85.41±10.11, t= 710.500,P= 0.860; proven IFI group: 100.98±19.24 vs. 103.21±17.66,t= 653.000,P= 0.449). Prior to the administration of albumin, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Youden index were 79.8%, 87.9%, 45.6%, 96.7%, 67.7%, respectively. However, after the administration of albumin, they were 81.5%, 85.7%, 44.8%, 96.5%, and 67.2%, respectively, without significant difference.Conclusions G test is method for early diagnosis of IFI. The sensitivity and specificity are higher with 20 ng/L as the critical value. The result of G test is not interfered by albumin administration.