Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2024 Jul 12;28(1):236.
doi: 10.1186/s13054-024-05022-x.

Prognostic value of serial (1,3)-β-D-glucan measurements in ICU patients with invasive candidiasis

Simone Carelli  1   2 , Brunella Posteraro  3   4 , Riccardo Torelli  5 , Elena De Carolis  5 , Maria Sole Vallecoccia  6 , Rikardo Xhemalaj  3   7 , Salvatore Lucio Cutuli  3   7 , Eloisa Sofia Tanzarella  3   7 , Antonio Maria Dell'Anna  3   7 , Gianmarco Lombardi  3   7 , Fabiola Cammarota  3   7 , Alessandro Caroli  3   7 , Domenico Luca Grieco  3   7 , Maurizio Sanguinetti  7   5 , Massimo Antonelli #  3   7 , Gennaro De Pascale #  3   7
Affiliations
Observational Study

Prognostic value of serial (1,3)-β-D-glucan measurements in ICU patients with invasive candidiasis

Simone Carelli et al. Crit Care. .

Abstract

Background: To determine whether a decrease in serum (1,3)-β-D-glucan (BDG) was associated with reduced mortality and to investigate the performance of BDG downslope in predicting clinical outcome in invasive candidiasis.

Methods: Observational cohort study in ICU patients over a ten-year period (2012-2022) in Italy. Proven invasive candidiasis with at least 2 BDG determinations were considered.

Results: In the study population of 103 patients (age 47 [35-62] years, SAPS II score 67 [52-77]) 68 bloodstream and 35 intrabdominal infections were recorded. Serial measurements showed that in 54 patients BDG decreased over time (BDG downslope group) while in 49 did not (N-BDG downslope group). Candida albicans was the pathogen most frequently isolated (61%) followed by C. parapsilosis (17%) and C. glabrata (12%), in absence of any inter-group difference. Invasive candidiasis related mortality was lower in BDG downslope than in N-BDG downslope group (17% vs 53%, p < 0.01). The multivariate Cox regression analysis showed the association of septic shock at infection occurrence and chronic liver disease with invasive candidiasis mortality (HR [95% CI] 3.24 [1.25-8.44] p = 0.02 and 7.27 [2.33-22.66] p < 0.01, respectively) while a BDG downslope was the only predictor of survival (HR [95% CI] 0.19 [0.09-0.43] p < 0.01). The area under the receiver operator characteristic curve for the performance of BDG downslope as predictor of good clinical outcome was 0.74 (p = 0.02) and our model showed that a BDG downslope > 70% predicted survival with both specificity and positive predictive value of 100%.

Conclusions: A decrease in serum BDG was associated with reduced mortality and a steep downslope predicted survival with high specificity in invasive candidiasis.

Keywords: (1, 3)-β-d-glucan; Biomarker; Downslope; Invasive candidiasis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan–Meier curves showing the cumulative incidence of invasive candidiasis related mortality in patients of the BDG and N-BDG downslope groups. BDG, (1,3)-β-d-glucan; IC, invasive candidiasis
Fig. 2
Fig. 2
Receiver operator characteristic curve of (1,3)-β-d-glucan downslope cutoff values to define invasive candidiasis related clinical outcome. The slope is expressed as 10-grouped variation in percentage between first and last (1,3)-β-d-glucan values (cfr. Table 3 for details)
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Calandra T, Roberts JA, Antonelli M, Bassetti M, Vincent J-L. Diagnosis and management of invasive candidiasis in the ICU: an updated approach to an old enemy. Crit Care. 2016;20:125. doi: 10.1186/s13054-016-1313-6. - DOI - PMC - PubMed
    1. Clancy CJ, Nguyen MH. Finding the “Missing 50%” of invasive candidiasis: How nonculture diagnostics will improve understanding of disease spectrum and transform patient care. Clin Infect Dis. 2013;56:1284–1292. doi: 10.1093/cid/cit006. - DOI - PubMed
    1. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the infectious diseases Society of America. Clinical infectious diseases. Oxford University Press; 2015. pp. e1–50. - PMC - PubMed
    1. Douglas CM. Fungal ß(1,3)-d-glucan synthesis. Med Mycol. 2001;39:55–66. doi: 10.1080/mmy.39.1.55.66. - DOI - PubMed
    1. De Carolis E, Marchionni F, Torelli R, Posteraro P, De Pascale G, Carelli S, et al. Comparable serum and plasma 1,3-β-d-glucan values using the Wako β-glucan test assay in patients with probable or proven fungal diseases. J Clin Microbiol. 2019;1–5. - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources