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Usage of 1,3-β-d-Glucan for Early Detection of Invasive Mycoses and Outcome Parameter in Immunocompromised Critically Ill Patients

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Abstract

Introduction

Invasive fungal disease (IFD) remains a significant cause of morbidity and mortality in critically ill patients.

Methods

Examination of 1,3-β-d-glucan (BDG) for IFD and as outcome parameter in immunocompromised critically ill patients with septic shock.

Results

Thirty-two (69 %) out of 46 included patients had BDG beyond the cutoff of >80 pg/ml (mean 320 pg/ml). Twelve (37 %) had findings of Aspergillus spp. in BAL (mean BDG 413 pg/ml). EORTC/MSG guidelines classified these as probable invasive aspergillosis (IA)/IFD. Five (16 %) had candidaemia (mean BDG level 361 pg/ml). Sensitivity of 78 % (95 % CI 58–88 %) and specificity of 68 % (95 % CI 52–77 %) for IFD were found on the BDG Fungitell assay. In detail, a sensitivity of 73 % (95 % 58–84 %) and specificity of 83 % (95 % CI 68–93 %) for IA and a sensitivity of 77 % (CI 95 % 62–87 %) and specificity 53 % (95 % CI 37–73 %) for candidaemia were found. APACHE II, SOFA score and mortality rate were in the elevated BDG group significantly altered (26 vs. 21, p < 0.003; 15 vs. 13, p < 0.006; 72 vs. 50 %, p < 0.004).

Conclusion

1,3-β-d-glucan assay is helpful for early detection of IFD; moreover, elevated BDG levels can be used as a predictor for outcome in immunocompromised critically ill patients as presented in our study.

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Authors’ Contribution

T.L., J.H., S.R., C.S., A.B., R.M.S. and W.H. were involved in study design. T.L., J.H., C.S., S.R., A.B. and W.H. were involved in data collection. T.L., J.H., C.S., S.R., A.B., R.M.S. and W.H. were involved in data analysis. T.L., J.H., C.S., S.R., A.B., R.M.S. and W.H. wrote the paper.

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Authors and Affiliations

  1. II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Tobias Lahmer, Sebastian Rasch, Christopher Schnappauf, Analena Beitz, Roland M. Schmid & Wolfgang Huber

  2. Mikrobiologisches Institut, Universitätsklinik Erlangen und Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany

    Jürgen Held

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  1. Tobias Lahmer
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  2. Jürgen Held
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Correspondence to Tobias Lahmer.

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Lahmer, T., Held, J., Rasch, S. et al. Usage of 1,3-β-d-Glucan for Early Detection of Invasive Mycoses and Outcome Parameter in Immunocompromised Critically Ill Patients. Mycopathologia 181, 815–821 (2016). https://doi.org/10.1007/s11046-016-0061-0

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  • DOI: https://doi.org/10.1007/s11046-016-0061-0

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