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. 2017 Apr 19;18(4):862.
doi: 10.3390/ijms18040862.

Detection of (1,3)-β-d-Glucan for the Diagnosis of Invasive Fungal Infection in Liver Transplant Recipients

Eric Levesque  1   2 , Fadi Rizk  3 , Zaid Noorah  4 , Nawel Aït-Ammar  5   6 , Catherine Cordonnier-Jourdin  7 , Sarra El Anbassi  8 , Christine Bonnal  9 , Daniel Azoulay  10 , Jean-Claude Merle  11 , Françoise Botterel  12   13
Affiliations

Detection of (1,3)-β-d-Glucan for the Diagnosis of Invasive Fungal Infection in Liver Transplant Recipients

Eric Levesque et al. Int J Mol Sci. .

Abstract

Invasive fungal infections (IFI) are complications after liver transplantation involving high morbidity and mortality. (1,3)-β-d-glucan (BG) is a biomarker for IFI, but its utility remains uncertain. This study was designed to evaluate the impact of BG following their diagnosis. Between January 2013 and May 2016, 271 liver transplants were performed in our institution. Serum samples were tested for BG (Fungitell®, Associates Cape Code Inc., Falmouth, MA, USA) at least weekly between liver transplantation and the discharge of patients. Nineteen patients (7%) were diagnosed with IFI, including 13 cases of invasive candidiasis (IC), eight cases of invasive pulmonary aspergillosis, and one case of septic arthritis due to Scedosporium apiospernum. Using a single BG sample for the primary analysis of IFI, 95% (21/22) of the subjects had positive BG (>80 pg/mL) at the time of IFI diagnosis. The area under the ROC curves to predict IFI was 0.78 (95% CI: 0.73-0.83). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of BG for IFI were 75% (95% CI: 65-83), 65% (62-68), 17% (13-21), and 96% (94-97), respectively. Based on their high NPV, the BG test appears to constitute a good biomarker to rule out a diagnosis of IFI.

Keywords: ">d-glucan; (1,3)-β-; invasive candidiasis; invasive fungal infection; invasive pulmonary aspergillosis; liver transplantation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient survival following liver transplantation as a function of invasive fungal infection status, p = 0.003.
Figure 2
Figure 2
Receiver operating characteristic (ROC) curves used to evaluate the ability of BG to diagnose (A) an invasive fungal infection (IFI): AUROC (Area under ROC) value of 0.78 (95% confidence interval (CI): 0.73–0.83); (B) Invasive pulmonary aspergillosis (IPA): AUROC value 0.77 (95% CI: 0.67–0.86); and (C) invasive candidiasis (IC): AUROC value 0.78 (95% CI: 0.72–0.84).
Figure 2
Figure 2
Receiver operating characteristic (ROC) curves used to evaluate the ability of BG to diagnose (A) an invasive fungal infection (IFI): AUROC (Area under ROC) value of 0.78 (95% confidence interval (CI): 0.73–0.83); (B) Invasive pulmonary aspergillosis (IPA): AUROC value 0.77 (95% CI: 0.67–0.86); and (C) invasive candidiasis (IC): AUROC value 0.78 (95% CI: 0.72–0.84).
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