PDF(Pubmed)
Abstract：
OBJECTIVE: Beta-D-Glucan (BDG) testing has been suggested to support the diagnosis of candidemia and invasive candidiasis. The actual benefit in critically ill high-risk patients in intensive care units (ICU) has not been verified so far.
METHODS: In ICU patients receiving empirical echinocandin treatment for suspected invasive candidiasis (IC), serial BDG testing using the Fujifilm Wako Beta-Glucan Test was performed, starting on the first day of echinocandin administration and every 24-48 h afterwards. Diagnostic accuracy was determined for single testing and serial testing strategies using a range of cut-off values. In addition, we compared the added value of these testing strategies when their results were introduced as additional predictors into a multivariable logistic regression model controlling for established risk factors of IC.
RESULTS: A total of 174 ICU patients, forty-six of which (25.7%) classified as cases of IC, were included in our study. Initial BDG testing showed moderate sensitivity (74%, 95%CI 59-86%) and poor specificity (45%, 95% CI 36-54%) for IC which could hardly be improved by follow-up testing. While raw BDG values or test results obtained with very high thresholds improved the predictive performance of our multivariable logistic regression model for IC, neither single nor serial testing with the manufacturer-proposed low-level cut-off showed substantial benefit.
CONCLUSIONS: In our study of critically ill intensive care patients at high risk for candidemia or invasive candidiasis, diagnostic accuracy of BDG testing was insufficient to inform treatment decisions. Improved classification was only achieved for cases with very high BDG values.
METHODS: In ICU patients receiving empirical echinocandin treatment for suspected invasive candidiasis (IC), serial BDG testing using the Fujifilm Wako Beta-Glucan Test was performed, starting on the first day of echinocandin administration and every 24-48 h afterwards. Diagnostic accuracy was determined for single testing and serial testing strategies using a range of cut-off values. In addition, we compared the added value of these testing strategies when their results were introduced as additional predictors into a multivariable logistic regression model controlling for established risk factors of IC.
RESULTS: A total of 174 ICU patients, forty-six of which (25.7%) classified as cases of IC, were included in our study. Initial BDG testing showed moderate sensitivity (74%, 95%CI 59-86%) and poor specificity (45%, 95% CI 36-54%) for IC which could hardly be improved by follow-up testing. While raw BDG values or test results obtained with very high thresholds improved the predictive performance of our multivariable logistic regression model for IC, neither single nor serial testing with the manufacturer-proposed low-level cut-off showed substantial benefit.
CONCLUSIONS: In our study of critically ill intensive care patients at high risk for candidemia or invasive candidiasis, diagnostic accuracy of BDG testing was insufficient to inform treatment decisions. Improved classification was only achieved for cases with very high BDG values.
摘要：
目的：β-D-葡聚糖（BDG）检测已被建议用于支持念珠菌血症和侵袭性念珠菌病的诊断。到目前为止，重症监护病房（ICU）中危重高危患者的实际收益尚未得到证实。
方法：在接受疑似侵袭性念珠菌病（IC）的经验性棘白菌素治疗的ICU患者中，使用富士胶片Wakoβ-葡聚糖测试进行系列BDG测试，从施用棘白菌素的第一天开始，之后每24-48小时。使用一系列截止值确定单次测试和连续测试策略的诊断准确性。此外,我们比较了这些测试策略在将结果作为额外预测因子引入多变量逻辑回归模型以控制已确定的IC危险因素时的附加值.
结果：总共174名ICU患者，其中46例(25.7%)被归类为IC病例，包括在我们的研究中。初始BDG测试显示中等灵敏度(74%，95CI59-86%）和特异性差（45%，95%CI36-54%)的IC，通过后续测试很难得到改善。虽然原始BDG值或以非常高的阈值获得的测试结果改善了我们用于IC的多变量逻辑回归模型的预测性能，制造商提出的低水平截止的单一或系列测试均未显示出实质性的好处。
结论：在我们对念珠菌菌血症或侵袭性念珠菌病高风险的危重重症监护患者的研究中，BDG检测的诊断准确性不足以为治疗决策提供依据.仅对于具有非常高的BDG值的病例实现了改进的分类。
方法：在接受疑似侵袭性念珠菌病（IC）的经验性棘白菌素治疗的ICU患者中，使用富士胶片Wakoβ-葡聚糖测试进行系列BDG测试，从施用棘白菌素的第一天开始，之后每24-48小时。使用一系列截止值确定单次测试和连续测试策略的诊断准确性。此外,我们比较了这些测试策略在将结果作为额外预测因子引入多变量逻辑回归模型以控制已确定的IC危险因素时的附加值.
结果：总共174名ICU患者，其中46例(25.7%)被归类为IC病例，包括在我们的研究中。初始BDG测试显示中等灵敏度(74%，95CI59-86%）和特异性差（45%，95%CI36-54%)的IC，通过后续测试很难得到改善。虽然原始BDG值或以非常高的阈值获得的测试结果改善了我们用于IC的多变量逻辑回归模型的预测性能，制造商提出的低水平截止的单一或系列测试均未显示出实质性的好处。
结论：在我们对念珠菌菌血症或侵袭性念珠菌病高风险的危重重症监护患者的研究中，BDG检测的诊断准确性不足以为治疗决策提供依据.仅对于具有非常高的BDG值的病例实现了改进的分类。
