Clinical analysis of serum galactomannan test for diagnosis of invasive fungal infection after HSCT in 113 paitents

Abstract

Objective To evaluate the value of serum galactomannan (GM) test for early diagnosis of invasive fungal infection (IFI) in HSCT patients.Method The clinical data were analysed retrospectively in 113 recipents subject to HSCT.According to domestic IFI diagnostic criteria,recipents were divided into proven IFI,probable IFI,possible IFI and non-IFI groups.The statistical software was used to calculate the sensitivity,specificity and predictive values.The risk factors of IFI and the efficacy of antifungal treatment were analyzed.The correlation between IFI and GM test was evaluated.Results Fourty-five patients (39.8％) were considered GM test positive from a total of 113 cases,and 39 patients were diagnosed as proven or probable IFI.Thirty-one cases of IFI (79.50％,31/39) were identified by GM test.The sensitivity,specificity,false positive rate and false negative rate were 79.5％,86.2％,13.8％,20.5％ respectively.The positive and negative predictive values were 79.5％ and 86.5％ respectively.The diagnose accordance rate was 83.5％,and the Younden index was 0.66.Moreover,GVHD,agranulocytosis and history of fungal infection were risk factors for IFI,and there was significant difference in the incidence of IFI between patients with primary disease of AML and those with ALL (P＜0.05).The total effective rate was 52.7％.The effective rate of the patients with proven and probable diagonisis was 66.7％.In addition,the GM value in paitents before antifungal treatment was significantly lower than that after treatment (P＜0.05),and the sooner the treatment began when GM test was positive,the better the effectiveness.Conclusion GM test is a useful method for early diagnosis of IFI in HSCT recipients.The dynamic monitoring of GM level can be useful for assessing therapeutic reponse. Key words: Hematopoietic stem cell transplantation; Invasive fungal infection; Galactomannan