PDF(Pubmed)
Abstract：
1,3-β-d-Glucan (BDG) is commonly used for diagnosing invasive fungal infections (IFIs). While exposure to cellulose-based hemodialyzers is known to cause false-positive BDG results, the impact of modern hemofilters used in continuous renal replacement therapy (CRRT) remains unclear. This retrospective, single-center cohort study aimed to evaluate the effect of CRRT on BDG levels in critically ill patients. We included adult intensive care unit (ICU) patients with ≥1 BDG measurement between December 2019 and December 2020. The primary outcome was the rate of false-positive BDG results in patients exposed to CRRT compared to unexposed patients. Propensity score analysis was performed to control for confounding factors. A total of 103 ICU patients with ≥1 BDG level were identified. Most (72.8%) were medical ICU patients. Forty patients underwent CRRT using hemofilter membranes composed of sodium methallyl sulfonate copolymer (AN 69 HF) (82.5%) and of polyarylethersulfone (PAES) (17.5%). Among the 91 patients without proven IFI, 31 (34.1%) had false-positive BDG results. Univariable analysis showed an association between CRRT exposure and false-positive BDG results. However, the association between CRRT exposure and false-positive BDG results was no longer significant across three propensity score models employed: 1:1 match (n = 32) (odds ratio (OR) 1.65, p = .48), model-adjusted (n = 91) (OR 1.75, p = .38), quintile-adjusted (n = 91) (OR 1.78, p = .36). In this single-center retrospective analysis, exposure to synthetic CRRT membranes did not independently increase the risk of false-positive BDG results. Larger prospective studies are needed to further evaluate the association between CRRT exposure and false-positive BDG results in critically ill patients with suspected IFI.
摘要：
1,3-β-d-葡聚糖(BDG)通常用于诊断侵袭性真菌感染(IFIs)。虽然已知暴露于基于纤维素的血液透析器会导致BDG结果假阳性，在连续性肾脏替代治疗(CRRT)中使用现代血液过滤器的影响尚不清楚.这次回顾，单中心队列研究旨在评估CRRT对危重患者BDG水平的影响。我们纳入了2019年12月至2020年12月之间BDG测量值≥1的成人重症监护病房（ICU）患者。主要结果是与未暴露的患者相比，暴露于CRRT的患者的BDG结果假阳性率。进行倾向评分分析以控制混杂因素。共有103名ICU患者的BDG水平≥1。大多数（72.8%）是内科ICU患者。40例患者使用由甲代烯丙基磺酸钠共聚物（AN69HF）（82.5％）和聚芳醚砜（PAES）（17.5％）组成的滤血膜进行了CRRT。在91例未被证实为FI的患者中，BDG结果假阳性31例(34.1%)。单变量分析显示CRRT暴露与BDG假阳性结果之间存在关联。然而,CRRT暴露与BDG假阳性结果之间的关联在采用的三个倾向评分模型中不再显著:1:1匹配(n=32)(比值比(OR)1.65,p=.48),模型调整(n=91)(OR1.75，p=0.38)，五分位数调整（n=91）（OR1.78，p=0.36）。在这个单中心回顾性分析中，接触合成CRRT膜并不独立增加BDG假阳性结果的风险.需要更大规模的前瞻性研究来进一步评估CRRT暴露和BDG假阳性结果之间的关系，在怀疑有FI的危重患者中。
