Clinical value of plasma (1-3)-β-D-glucan for diagnosis of fungal bloodstream infection / 第二军医大学学报

ABSTRACT

[Abstract] Objective To investigate the clinical value of plasma (1-3)-β-D-glucan test (G test) for diagnosis of fungal bloodstream infection. Methods The blood samples for fungal culturing and G test were collected in Changhai Hospital of Naval Medical University (Second Military Medical University) from Jan. 2015 to Dec. 2017. The department distribution and strain distribution of 264 positive specimens detected by fungal blood culture were analyzed. A total of 1 678 samples were collected during this period for fungal blood culture and plasma G test. Taking fungal blood culture as the criterion, with a cut-off of 100.5 pg/mL for G test, we analyzed the sensitivity, specificity, positive forecast value, and negative forecast value of G test for diagnosis of fungal bloodstream infection. Statistical analysis was performed using SPSS 19.0 software, and the diagnostic value of G test for bloodstream infection was judged by the receiver operating characteristic (ROC) curve. Results A total of 264 strains of fungal blood culture were positive from 2015 to 2017, mainly from the departments of hepatobiliary surgery (81 strains), cardiac surgery (57 strains), emergency (24 strains), thoracic surgery (22 strains), and hematology (16 strains). Candida is the main genus, of which Candida parapsilosis is the most common one, with 142 strains (53.8%), followed by Candida corneum (36 stains, 13.6%), Candida albicans (20 strains, 7.6%) and Candida tropical (18 strains, 6.8%). Taking fungal blood culture as the criterion, we found that the sensitivity, specificity, positive forecast value, and negative forecast value of G test for diagnosis of fungal infection were 61.3%, 87.9%, 31.1%, and 96.2%, respectively. ROC curve analysis showed that G test was valuable for diagnosis of fungal bloodstream infection, with the area under the curve being 0.771 (95% confidence interval 0.723-0.819). Among 137 cases of bloodstream infection, 102 cases (69.6%) were tested for G test 2-5 d before blood culture, and 71 cases were positive. Conclusion Plasma G test kit is still ideal in terms of specificity and has a certain clinical value for the early diagnosis of fungal bloodstream infection.