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How to interpret serum levels of beta-glucan for the diagnosis of invasive fungal infections in adult high-risk hematology patients: optimal cut-off levels and confounding factors

  • H. HammarströmEmail author
  • N. Kondori
  • V. Friman
  • C. Wennerås
Article

Abstract

Detection of the fungal cell wall component beta-glucan (BG) in serum is increasingly used to diagnose invasive fungal infections (IFI), but its optimal use in hematology patients with high risk of IFI is not well defined. We retrospectively analyzed the diagnostic accuracy, optimal cut-off level, and potential confounding factors of BG reactivity. The inclusion criteria were: adult patients with hematologic disease who were admitted to the hematology ward during the 2-year study period and who had two or more consecutive BG assays performed. In total, 127 patients were enrolled. Thirteen patients with proven or probable IFI, as defined by the 2008 European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria, were identified. Receiver operating characteristic (ROC) curve analysis showed a high overall diagnostic performance (area under the ROC curve = 0.98) and suggested an optimal cut-off level of 158 pg/ml, with a sensitivity and a specificity of 92 % and 96 %, respectively. Multiway analysis of variance indicated that treatment with pegylated asparaginase (p < 0.001), admission to the intensive care unit (ICU; p = 0.0007), and treatment with albumin, plasma, or coagulation factors (p = 0.01) are potential confounding factors of BG reactivity. We propose that a higher cut-off level than that recommended by the manufacturer should be used to monitor adult hematology patients at high risk for IFI. Our results also suggest that elevated BG levels in patients treated with pegylated asparaginase, albumin, plasma, or coagulation factors, or those admitted to the ICU should be interpreted with caution.

Keywords

Diagnostic Performance Invasive Fungal Infection Asparaginase Hematopoietic Stem Cell Transplant Recipient Invasive Fungal Infection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

This study was financed by Västra Götaland Health Care Region ALF project grants (ALF 71580 and ALF 74860), Strategic ALF Transplantation project grant (ALF 74080), and the Cancer and Allergy Foundation.

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical standards

The study was approved by the Regional Ethics Committee of Göteborg and has been performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments. The Ethics Committee assessed that there was no requirement of informed consent by the patients due to the structure of the study.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • H. Hammarström
    • 1
    Email author
  • N. Kondori
    • 1
  • V. Friman
    • 1
  • C. Wennerås
    • 1
  1. 1.Department of Infectious DiseasesSahlgrenska Academy at University of Gothenburg, Sahlgrenska University HospitalGöteborgSweden

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