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. 2023 Nov 11;9(2):287-295.
doi: 10.1016/j.ekir.2023.11.002. eCollection 2024 Feb.

Serum Galactomannan: A Predictor of Poor Outcomes in Peritoneal Dialysis Patients With Fungal Peritonitis

Talerngsak Kanjanabuch  1   2   3 , Tanawin Nopsopon  4 , Thunvarat Saejew  2 , Athiphat Banjongjit  5 , Pongpratch Puapatanakul  1 , Somkanya Tungsanga  1   6 , Jakapat Vanichanan  7 , Sajja Tatiyanupanwong  8 , Kanjana Tianprasertkij  9 , Worapot Treamtrakanpon  10 , Uraiwan Parinyasiri  11 , Kamol Khositrangsikun  12 , Oranan Thamvichitkul  13 , Pichet Lorvinitnun  14 , Sriphrae Uppamai  15 , Rhonachai Lawsuwanakul  16 , Mananya Wanpaisitkul  17 , Saowalak Chowpontong  18 , Rutchanee Chieochanthanakij  19 , Somchai Eiam-Ong  1 , Jeffrey Perl  20 , David W Johnson  21   22   23
Affiliations

Serum Galactomannan: A Predictor of Poor Outcomes in Peritoneal Dialysis Patients With Fungal Peritonitis

Talerngsak Kanjanabuch et al. Kidney Int Rep. .

Abstract

Introduction: The potential value of serum galactomannan index (GMI) in monitoring treatment response in patients with fungal peritonitis who are receiving peritoneal dialysis (PD) was assessed in the present study.

Methods: The study included all Thailand fungal PD-related infectious complications surveillance (MycoPDICS) DATA study participants who had timely PD catheter removal and availability of both baseline and ≥2 subsequent serum GMI measurements after starting antifungal therapy (if available). Serum GMI was assessed by direct double-sandwich enzyme-linked immunosorbent assay with reference to positive and negative control samples. Comparisons of categorical variables among groups were analyzed by Fisher's exact test for categorical data and the Wilcoxon rank-sum test for continuous variables. Mortality outcomes were analyzed by survival analyses using Kaplan-Meier curves with Log-rank test.

Results: Seventy-six (46%) of 166 participants from 21 PD centers between 2018 and 2022 were included. The median age was 58 (50-65) years, and a half of the patients (50%) had type II diabetes. Nineteen (25%) and 57 (75%) episodes were caused by yeast and mold, respectively. Death occurred in 11 (14%) patients at 3 months, and no differences were observed in demographics, laboratories, treatment characteristics, or in baseline serum GMI between those who died and those who survived. Serum GMI progressively declined over the follow-up period after the completion of treatment. Patients who died had significantly higher posttreatment serum GMI levels and were more likely to have positive GMI after treatment.

Conclusion: Serum GMI is an excellent biomarker for risk stratification and treatment response monitoring in patients on PD with fungal peritonitis.

Keywords: GM cut-off value; MycoPDICS; fungal peritonitis; galactomannan; peritoneal dialysis; predictor.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Patient flow diagram. GMI, galactomannan index; PD, peritoneal dialysis.
Figure 2
Figure 2
Serial serum GMI during the study period. IQR, interquartile range.
Figure 3
Figure 3
The survival probability between patients with GMIs below vs. above cut-off after the completion of antifungal treatment. Remark: One death occurred at 3 months after submitting serum GM.
See this image and copyright information in PMC

References

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