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. 2018 Apr 23;13(4):e0196196.
doi: 10.1371/journal.pone.0196196. eCollection 2018.

Serum galactomannan antigen as a prognostic and diagnostic marker for invasive aspergillosis in heterogeneous medicine ICU patient population

Yubhisha Dabas  1 , Anant Mohan  2 , Immaculata Xess  1
Affiliations

Serum galactomannan antigen as a prognostic and diagnostic marker for invasive aspergillosis in heterogeneous medicine ICU patient population

Yubhisha Dabas et al. PLoS One. .

Abstract

Objective: This study was conducted to get a complete clinical and mycological picture of invasive aspergillosis (IA) in respiratory medicine ICU of a tertiary care hospital.

Patients: From the cohort of 235 patients only one had proven IA. Based on AspICU algorithm, 21 had putative IA (8.9%), 12 were colonised (5.1%).

Results: Adjusting the confounding factors, significant risk factors for IA were chronic obstructive pulmonary disease (COPD), temperature of ≥38°C, pneumonia and acute respiratory distress syndrome (ARDS). The best predictor of IA was AspICU algorithm (AUC, 1) followed by serum galactomannan antigen (GM) cut-off (≥1.24) calculated based on AspICU algorithm (AUC, 0.822). For 37% of patients, IA diagnoses was made earlier with serum GM than radiology. There were 70/235 (29.8%) deaths within 30 days of enrolment in the study. Aspergillus culture positivity (34/235, 14.5%) was associated with very high mortality (27/34, 79.4%), (p<0.05). The best predictor of mortality was GM cut-off (≥1.24) calculated based on AspICU algorithm (AUC, 0.835).

Conclusion: This study imparts the focus on relatively underestimated Aspergillus infections prevalent in ICUs. The AspICU algorithm was found to be useful over others for IA diagnosis. The prognostic usefulness of serum GM antigen detection test highlighted overlooking the same may not be rewarding for the outcome of IA suspected ICU subpopulation.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Significant GM cut-off on the basis of AspICU algorithm (for calculation proven and putative IA cases are taken as one group whilst combining others together).
Fig 2
Fig 2. Significant GM cut-off according to IA cases defined on the basis of EORTC/MSG criteria (for calculation proven and probable IA cases are taken as one group whilst combining others together).
Fig 3
Fig 3. Diagnostic accuracy for the detection of invasive aspergillosis with different tests and diagnostic criteria (using clinically relevant microscopy and culture positive cases as the reference).
Fig 4
Fig 4. Predictor markers of mortality (using the final outcome as the reference).
See this image and copyright information in PMC

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