Abstract
The objective of this study was to explore the diagnostic value of the bronchoalveolar lavage fluid galactomannan (BALF GM) test for chronic respiratory disease with pulmonary aspergillosis and to establish the optimal cutoff value. Samples from a total of 309 chronic respiratory disease patients seen at the respiratory medicine department of Peking University Shenzhen Hospital from September 2016 to September 2019 were analyzed. According to the diagnostic criteria, we divided the patients into a case group (n = 79, comprising 25 proven cases and 54 probable cases) and a control group (n = 230). Bronchoalveolar lavage fluid was collected, and the BALF GM test results were analyzed. A nonparametric rank sum test showed that the mean rank of the case group was 255.30, which was higher than that of the control group (120.55). The Z-value was -11.567 (P = 0.000), indicating that the general distributions of BALF GM differed between the two groups. A BALF GM cutoff value of 0.88 showed the highest diagnostic efficacy for pulmonary aspergillosis. The sensitivity, specificity, positive predictive value, and negative predictive value were 77.2%, 93%, 79.2%, and 92.2%, respectively. As the cutoff value increased, the specificity and sensitivity of the BALF GM test increased and decreased, respectively. The BALF GM test can be used confirm the diagnosis of patients with pulmonary aspergillosis and chronic respiratory disease. The optimum BALF GM cutoff value is 0.88.
Highlights
In the retrospective study by Guinea et al.,[5] Aspergillus was isolated from 239 of 14,618 patients with chronic obstructive pulmonary disease (COPD), pulmonary aspergillosis was diagnosed in 53 patients, 38 of whom died within 4 months of diagnosis
In order to evaluate whether the GM of alveolar lavage fluid be a diagnostic marker for patients with chronic airway diseases complicated with pulmonary aspergillosis, and to find out the appropriate GM cut-off value,We studied patients with COPD, bronchial asthma, bronchiectasis and other chronic respiratory diseases commonly seen in the Department of Respiratory Medicine, Peking University Shenzhen
According to the 2016 Infectious Diseases of America (IDSA) guidelines on Aspergillus infection diagnosis and treatment [6], together with the diagnostic criteria for invasive fungal infections used in China[7], the cases of chronic respiratory disease with pulmonary aspergillosis were classified as follows: (1) Proven: a lower respiratory tract specimen positive for Aspergillus, with confirmation by molecular, immunological, and/or culture methods that the observed hyphae were of Aspergillus
Summary
University Shenzhen Hospital from September 2017 to September 2018 were analyzed. According to the diagnostic criteria, we divided the patients into the case group (n = 70, comprising 5, 20, and 45 proven, probable, and possible cases, respectively) and the control group (n = 110). Bronchoalveolar lavage fluid was collected, and the BALF GM test results were analyzed. Results A non-parametric rank-sum test showed that the mean rank of the case group was 140.80, which was higher than that of the control group (58.49). A BALF GM cut-off value of 0.485 showed the highest diagnostic efficacy for pulmonary aspergillosis. The sensitivity, specificity, positive predictive value, and negative predictive value were 92.9%, 100%, 92.8%, and 100%, respectively. As the cut-off value increased, the specificity and sensitivity of the BALF GM test increased and decreased, respectively
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