Abstract
BackgroundThe use of galactomannan (GM) testing in plasma and bronchoalveolar lavage fluid (BALF) has improved the diagnosis of invasive pulmonary aspergillosis (IPA) in patients with chronic obstructive pulmonary disease (COPD); however, the high false-positive rate leads to overdiagnosis. Pentraxin 3 (PTX3) as an indicator of inflammation plays an important role in resistance to Aspergillus infections. This study aimed to investigate the diagnostic value of PTX3 for diagnosing IPA with COPD.MethodsWe retrospectively collected data on patients with suspected COPD and IPA who had been hospitalized in the Third Affiliated Hospital of Soochow University between September 2017 and November 2020. PTX3 and GM were measured using enzyme-linked immunosorbent assays.ResultsA total of 165 patients were included in the study, of whom 35 had confirmed or probable IPA. The remaining 130 patients served as controls. The median plasma and BALF PTX3 levels were significantly higher in patients with IPA than in control patients (3.74 ng/mL vs. 1.29 ng/mL, P < 0.001; and 3.88 ng/mL vs. 1.58 ng/mL, P < 0.001 in plasma and BALF, respectively). The plasma GM, plasma PTX3, BALF GM, and BALF PTX3 assays had sensitivities of 60.0%, 77.1%, 78.6%, and 89.3%, respectively, and specificities of 73.8%, 69.2%, 80.7%, and 77.1%, respectively. The sensitivity of PTX3 in plasma and BALF was higher than that of GM. However, the specificity of PTX3 and GM did not differ significantly between the IPA group and the control group. The specificity of the assays for the diagnosis of IPA was > 90% in patients who were PTX3-positive and GM-positive in plasma and BALF.ConclusionsBALF and plasma PTX3 levels were significantly higher in COPD patients with IPA. The sensitivity of PTX3 was superior to that of GM for diagnosing IPA in patients with COPD. The combination of GM and PTX3 is useful for the diagnosis of IPA in patients with COPD.
Highlights
The use of galactomannan (GM) testing in plasma and bronchoalveolar lavage fluid (BALF) has improved the diagnosis of invasive pulmonary aspergillosis (IPA) in patients with chronic obstructive pulmonary disease (COPD); the high false-positive rate leads to overdiagnosis
In this study, we evaluated the diagnostic value of BALF and plasma Pentraxin 3 (PTX3) levels in COPD patients with IPA
Patient characteristics A total of 165 patients were included, of whom 35 were diagnosed with IPA and COPD according to the Infectious Diseases Society of America guideline criteria (3 confirmed; 32 probable), and 130 COPD patients without IPA served as controls (Fig. 1)
Summary
The use of galactomannan (GM) testing in plasma and bronchoalveolar lavage fluid (BALF) has improved the diagnosis of invasive pulmonary aspergillosis (IPA) in patients with chronic obstructive pulmonary disease (COPD); the high false-positive rate leads to overdiagnosis. Pentraxin 3 (PTX3) as an indicator of inflammation plays an important role in resistance to Aspergillus infections. Invasive pulmonary aspergillosis (IPA) is a serious opportunistic infection caused by Aspergillus spp. The incidence of IPA has gradually increased in patients with chronic obstructive pulmonary disease (COPD). Current research suggests that the occurrence of pulmonary Aspergillus infection in patients with COPD is related to the long-term use of glucocorticoids and antibiotics. Patients with COPD and pulmonary invasive aspergillosis often present with atypical symptoms and imaging [1]. The Infectious Diseases Society of America guidelines (IDSA) recommend testing plasma and bronchoalveolar
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