Diagnostic accuracy of the 1,3-beta-d-glucan test and lactate dehydrogenase for pneumocystis pneumonia in non-HIV patients

Ruixue Sun,Meng Xiao,Jing Yang,Huadong Zhu,Li Zhang,Jun Xu,Dan Lv,Xuezhong Yu

doi:10.1038/s41598-021-88729-z

Abstract

We evaluated the serum levels of (1–3)-beta-d-glucan (BG) and lactate dehydrogenase (LDH) as a tool to support pneumocystis pneumonia (PCP) diagnostic procedures in non-HIV patients. We retrospectively collected non-HIV (human immunodeficiency virus) patients presenting clinical features of PCP between April 1st, 2013, and December 31st, 2018. A total of 225 included patients were tested for Pneumocystis jirovecii by polymerase chain reaction (PCR) and methenamine silver staining. Based on different exclusion criteria, 179 cases were included in the BG group, and 196 cases were included in the LDH group. In each group, cases with positive immunofluorescence (IF) microscopy and PCR were considered proven PCP, while cases with only positive PCR were considered probable PCP. Fifty patients with negative IF and PCR results and proven to be non-PCP infection were chosen randomly as the control group. The cut-off levels of BG and LDH to distinguish non-PCP from probable PCP were 110 pg/mL and 296 U/L with 88% sensitivity and 86% specificity, and 66% sensitivity and 88% specificity, respectively. The cut-off levels of BG and LDH to distinguish non-PCP from proven PCP were 285.8 pg/mL and 379 U/L with 92% sensitivity and 96% specificity, and 85% sensitivity and 77% specificity, respectively. The cut-off levels of BG and LDH to distinguish non-PCP from proven/probable PCP were 144.1 pg/mL and 363 U/L with 90% sensitivity, 86% specificity and 80% sensitivity, 76% specificity respectively. BG and LDH are reliable indicators for detecting P. jirovecii infection in HIV-uninfected immunocompromised patients.

Highlights

We evaluated the serum levels of [1,2,3]-beta-d-glucan (BG) and lactate dehydrogenase (LDH) as a tool to support pneumocystis pneumonia (PCP) diagnostic procedures in non-HIV patients
The organism cannot be cultured in clinical laboratories, so the diagnosis depends on examination of respiratory secretions usually obtained by invasive bronchoscopy, and visualization of the organism in respiratory secretions requires special staining techniques19
The results supported that these two biomarkers have excellent power for discriminating proven PCP or probable PCP from non-PCP patients

Summary

Methods

Patients with negative methenamine silver staining and PCR results that proved to be non-PCP infections were chosen randomly as the control group, and they matched the exclusion criteria of the BG case group and LDH case group (Fig. 1: patient sample flow). We collected patient information, including age, sex, length of hospital stays, ICU stay, risk factors (autoimmune disease, haematological malignancies, solid tumour, organ transplantation, bone marrow transplantation), therapy history (glucocorticoid, immunosuppressant and preventive dose of sulfanilamide), clinical manifestation (fever, cough, wheeze), chest CT features, level of BG and LDH, methenamine silver stain and PCP PCR test results, and prognosis. For patients < 18 years old, informed Consent was obtained from parents and/or legal guardian

Result

Findings

Discussion