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Abstract：
BACKGROUND: To determine whether a decrease in serum (1,3)-β-D-glucan (BDG) was associated with reduced mortality and to investigate the performance of BDG downslope in predicting clinical outcome in invasive candidiasis.
METHODS: Observational cohort study in ICU patients over a ten-year period (2012-2022) in Italy. Proven invasive candidiasis with at least 2 BDG determinations were considered.
RESULTS: In the study population of 103 patients (age 47 [35-62] years, SAPS II score 67 [52-77]) 68 bloodstream and 35 intrabdominal infections were recorded. Serial measurements showed that in 54 patients BDG decreased over time (BDG downslope group) while in 49 did not (N-BDG downslope group). Candida albicans was the pathogen most frequently isolated (61%) followed by C. parapsilosis (17%) and C. glabrata (12%), in absence of any inter-group difference. Invasive candidiasis related mortality was lower in BDG downslope than in N-BDG downslope group (17% vs 53%, p < 0.01). The multivariate Cox regression analysis showed the association of septic shock at infection occurrence and chronic liver disease with invasive candidiasis mortality (HR [95% CI] 3.24 [1.25-8.44] p = 0.02 and 7.27 [2.33-22.66] p < 0.01, respectively) while a BDG downslope was the only predictor of survival (HR [95% CI] 0.19 [0.09-0.43] p < 0.01). The area under the receiver operator characteristic curve for the performance of BDG downslope as predictor of good clinical outcome was 0.74 (p = 0.02) and our model showed that a BDG downslope > 70% predicted survival with both specificity and positive predictive value of 100%.
CONCLUSIONS: A decrease in serum BDG was associated with reduced mortality and a steep downslope predicted survival with high specificity in invasive candidiasis.
METHODS: Observational cohort study in ICU patients over a ten-year period (2012-2022) in Italy. Proven invasive candidiasis with at least 2 BDG determinations were considered.
RESULTS: In the study population of 103 patients (age 47 [35-62] years, SAPS II score 67 [52-77]) 68 bloodstream and 35 intrabdominal infections were recorded. Serial measurements showed that in 54 patients BDG decreased over time (BDG downslope group) while in 49 did not (N-BDG downslope group). Candida albicans was the pathogen most frequently isolated (61%) followed by C. parapsilosis (17%) and C. glabrata (12%), in absence of any inter-group difference. Invasive candidiasis related mortality was lower in BDG downslope than in N-BDG downslope group (17% vs 53%, p < 0.01). The multivariate Cox regression analysis showed the association of septic shock at infection occurrence and chronic liver disease with invasive candidiasis mortality (HR [95% CI] 3.24 [1.25-8.44] p = 0.02 and 7.27 [2.33-22.66] p < 0.01, respectively) while a BDG downslope was the only predictor of survival (HR [95% CI] 0.19 [0.09-0.43] p < 0.01). The area under the receiver operator characteristic curve for the performance of BDG downslope as predictor of good clinical outcome was 0.74 (p = 0.02) and our model showed that a BDG downslope > 70% predicted survival with both specificity and positive predictive value of 100%.
CONCLUSIONS: A decrease in serum BDG was associated with reduced mortality and a steep downslope predicted survival with high specificity in invasive candidiasis.
摘要：
背景：为了确定血清（1,3）-β-D-葡聚糖（BDG）的减少是否与死亡率降低相关，并研究BDG下坡在预测侵袭性念珠菌病临床结局中的表现。
方法：对意大利ICU患者进行了10年（2012-2022年）的观察性队列研究。已证明具有至少2个BDG测定的侵袭性念珠菌病被考虑。
结果：在103名患者的研究人群中（年龄47[35-62]岁，SAPSII评分67[52-77]）记录了68例血流和35例腹腔内感染。连续测量显示，在54例患者中，BDG随时间减少（BDG下坡组），而在49例未减少（N-BDG下坡组）。白色念珠菌是最常见的病原体（61％），其次是梭菌（17％）和光滑梭菌（12％），在没有任何组间差异的情况下。BDG下坡的侵袭性念珠菌病相关死亡率低于N-BDG下坡组(17%vs53%,p<0.01)。多变量Cox回归分析显示感染性休克和慢性肝病与侵袭性念珠菌病死亡率的相关性（HR[95％CI]3.24[1.25-8.44]p=0.02和7.27[2.33-22.66]p<0.01，分别），而BDG下坡率是生存的唯一预测指标（HR[95％CI]0.19[0.09-0.43]p<0.01）。BDG下坡作为良好临床结果的预测指标的受试者操作员特征曲线下面积为0.74（p=0.02），我们的模型显示BDG下坡>70％预测生存率，特异性和阳性预测值均为100％。
结论：在侵袭性念珠菌病中，血清BDG的降低与死亡率的降低相关，而高特异性的急剧下降预测生存率。
方法：对意大利ICU患者进行了10年（2012-2022年）的观察性队列研究。已证明具有至少2个BDG测定的侵袭性念珠菌病被考虑。
结果：在103名患者的研究人群中（年龄47[35-62]岁，SAPSII评分67[52-77]）记录了68例血流和35例腹腔内感染。连续测量显示，在54例患者中，BDG随时间减少（BDG下坡组），而在49例未减少（N-BDG下坡组）。白色念珠菌是最常见的病原体（61％），其次是梭菌（17％）和光滑梭菌（12％），在没有任何组间差异的情况下。BDG下坡的侵袭性念珠菌病相关死亡率低于N-BDG下坡组(17%vs53%,p<0.01)。多变量Cox回归分析显示感染性休克和慢性肝病与侵袭性念珠菌病死亡率的相关性（HR[95％CI]3.24[1.25-8.44]p=0.02和7.27[2.33-22.66]p<0.01，分别），而BDG下坡率是生存的唯一预测指标（HR[95％CI]0.19[0.09-0.43]p<0.01）。BDG下坡作为良好临床结果的预测指标的受试者操作员特征曲线下面积为0.74（p=0.02），我们的模型显示BDG下坡>70％预测生存率，特异性和阳性预测值均为100％。
结论：在侵袭性念珠菌病中，血清BDG的降低与死亡率的降低相关，而高特异性的急剧下降预测生存率。
