Comparison of Serum Galactomannan and 1,3-Beta-d-Glucan Determination for Early Detection of Invasive Pulmonary Aspergillosis in Critically Ill Patients with Hematological Malignancies and Septic Shock

Abstract

Invasive pulmonary aspergillosis (IPA) is an important cause of morbidity/mortality in critically ill patients with hematological malignancies. New diagnosis strategies include the noninvasive biomarkers 1,3-beta-D-glucan (BDG) and serum galactomannan (GM). For early detection of IPA, we compared BDG Fungitell assay with GM Platelia assay. Twenty-two out of 30 patients (74%) had elevated BDG levels (mean 306pg/ml) beyond the cutoff of 80pg/ml. GM levels were elevated in only 3 patients (10%) over the ODI cutoff of >0.5. Following the BDG/GM and microbiological findings, 10 (34%) cases were classified as probable IPA and 12 (40%) as possible IPA. Eight (26%) were classified as no IPA. An overall sensitivity of 90% (95% CI 86-96%) and specificity of 85% (95% CI 79-86%) was found for the BDG Fungitell assay in IPA. In contrast, an overall sensitivity of 30% (95% CI 26-38%) and specificity of 98% (95% CI 94-100%) was found for the GM Platelia assay. A false-negative rate of 70% for probable IPA and 85% for probable/possible IPA was detected for GM. The false-negative rate for BDG was 0% in cases of probable IPA and 45% in cases of possible cases. BDG is a sensitive marker for patients' surveillance at risk of IPA. In patients with hematological malignancies and septic shock, early diagnosis of IPA might be significantly improved by BDG compared to GM, also considering that BDG has the advantage of detecting fungal diseases other than IPA.