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. 2021 Aug 21;11(1):129.
doi: 10.1186/s13613-021-00918-1.

Monocyte human leukocyte antigen-DR but not β-D-glucan may help early diagnosing invasive Candida infection in critically ill patients

Boris Jung  1   2 , Clément Le Bihan  3   4 , Pierre Portales  5 , Nathalie Bourgeois  6 , Thierry Vincent  5 , Laurence Lachaud  6 , Gerald Chanques  2   4 , Matthieu Conseil  4 , Philippe Corne  1 , Pablo Massanet  7 , Jean François Timsit  8 , Samir Jaber  9   10
Affiliations

Monocyte human leukocyte antigen-DR but not β-D-glucan may help early diagnosing invasive Candida infection in critically ill patients

Boris Jung et al. Ann Intensive Care. .

Abstract

Background: Precision medicine risk stratification is desperately needed to both avoid systemic antifungals treatment delay and over prescription in the critically ill with risk factors. The aim of the present study was to explore the combination of host immunoparalysis biomarker (monocyte human leukocyte antigen-DR expression (mHLA-DR)) and Candida sp wall biomarker β-D-glucan in risk stratifying patients for secondary invasive Candida infection (IC).

Methods: Prospective observational study. Two intensive care units (ICU). All consecutive non-immunocompromised septic shock patients. Serial blood samples (n = 286) were collected at day 0, 2 and 7 and mHLA-DR and β-D-glucan were then retrospectively assayed after discharge. Secondary invasive Candida sp infection occurrence was then followed at clinicians' discretion.

Results: Fifty patients were included, 42 (84%) had a Candida score equal or greater than 3 and 10 patients developed a secondary invasive Candida sp infection. ICU admission mHLA-DR expression and β-D-glucan (BDG) failed to predict secondary invasive Candida sp infection. Time-dependent cause-specific hazard ratio of IC was 6.56 [1.24-34.61] for mHLA-DR < 5000 Ab/c and 5.25 [0.47-58.9] for BDG > 350 pg/mL. Predictive negative value of mHLA-DR > 5000 Ab/c and BDG > 350 pg/mL combination at day 7 was 81% [95% CI 70-92].

Conclusions: This study suggests that mHLA-DR may help predicting IC in high-risk patients with septic shock. The added value of BDG and other fungal tests should be regarded according to the host immune function markers.

Keywords: Beta D-glucan; Candidiasis; Septic shock; mHLA-DR.

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Conflict of interest statement

SJ declares consulting fees from Drager, Xenios and Fisher & Paykel. BJ does not declare any conflicts of interests. GC declares speaker fees from Aspen medical and Orion pharma and consulting fees from Orion pharma. JFT declares speaker fees from Merck, Pfizer, Biomerieux; consulting fees from Pfizer, Gilead, Merck, Nabriva, Paratek, Medimune and research grants from 3M, Merck, Pfizer. Other authors do not declare any conflicts of interests.

Figures

Fig. 1
Fig. 1
Flowchart. IC Invasive Candida Infection, ICU intensive care unit
Fig. 2
Fig. 2
A Time course of mHLA-DR from day 0 to day 7 post septic shock. Results are expressed as mean ± SEM. Difference between IC and NIC from day 0 to day 7 is not significant. However, considering day 7 and day 0, mHLA-DR was different between IC and NIC patients. B Time course of β-d-glucan from day 0 to day 7 post septic shock. Results are expressed as mean ± SEM. Difference between IC and NIC is not significant
Fig. 3
Fig. 3
A Probability of Invasive Candida Infection after day 7 according to Day 7 mHLA-DR (Ab/cell). B. Probability of Invasive Candida Infection after day 7 according to day 7 β-d-glucan (pg/mL)
See this image and copyright information in PMC

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