Serum galactomannan antigen as a prognostic and diagnostic marker for invasive aspergillosis in heterogeneous medicine ICU patient population.

Yubhisha Dabas,Immaculata Xess,Anant Mohan,Chiara Lazzeri

doi:10.1371/journal.pone.0196196

Yubhisha Dabas, Immaculata Xess + Show 2 more

Open Access

https://doi.org/10.1371/journal.pone.0196196

Copy DOI

Journal: PloS one	Publication Date: Apr 23, 2018
Citations: 15	License type: CC BY 4.0

Affiliation: All India Institute of Medical Sciences

Abstract

ObjectiveThis study was conducted to get a complete clinical and mycological picture of invasive aspergillosis (IA) in respiratory medicine ICU of a tertiary care hospital.PatientsFrom the cohort of 235 patients only one had proven IA. Based on AspICU algorithm, 21 had putative IA (8.9%), 12 were colonised (5.1%).ResultsAdjusting the confounding factors, significant risk factors for IA were chronic obstructive pulmonary disease (COPD), temperature of ≥38°C, pneumonia and acute respiratory distress syndrome (ARDS). The best predictor of IA was AspICU algorithm (AUC, 1) followed by serum galactomannan antigen (GM) cut-off (≥1.24) calculated based on AspICU algorithm (AUC, 0.822). For 37% of patients, IA diagnoses was made earlier with serum GM than radiology. There were 70/235 (29.8%) deaths within 30 days of enrolment in the study. Aspergillus culture positivity (34/235, 14.5%) was associated with very high mortality (27/34, 79.4%), (p<0.05). The best predictor of mortality was GM cut-off (≥1.24) calculated based on AspICU algorithm (AUC, 0.835).ConclusionThis study imparts the focus on relatively underestimated Aspergillus infections prevalent in ICUs. The AspICU algorithm was found to be useful over others for IA diagnosis. The prognostic usefulness of serum GM antigen detection test highlighted overlooking the same may not be rewarding for the outcome of IA suspected ICU subpopulation.

Highlights

Invasive Aspergillosis (IA) is considered a major threat for hemato-oncological and transplant patients whereas often underestimated in intensive care units (ICUs) [1, 2]
This study imparts the focus on relatively underestimated Aspergillus infections prevalent in ICUs
The AspICU algorithm was found to be useful over others for IA diagnosis

Summary

Introduction

Invasive Aspergillosis (IA) is considered a major threat for hemato-oncological and transplant patients whereas often underestimated in intensive care units (ICUs) [1, 2]. For IA diagnosis in neutropenic/transplant patient group, the European Organization for Research and Treatment of Cancer/National Institute of Allergy and Infectious Diseases Mycosis Study Group (EORTC/MSG) diagnostic criteria is followed which in many studies is used to extrapolate results in ICU settings as well [10, 11]. In recent years, another more feasible criterion for critically ill patients has been introduced by Blot et al which clearly distinguishes Aspergillus colonisation from the infection cases [12]. Majority of the studies following this criterion are done retrospectively probably to simplify the interpretation of Aspergillus-positive lower respiratory tract samples [2, 12, 13]

Methods

Results

Conclusion