%0 Journal Article
%T Prognostic value of serial (1,3)-β-D-glucan measurements in ICU patients with invasive candidiasis.
%A Carelli S
%A Posteraro B
%A Torelli R
%A De Carolis E
%A Vallecoccia MS
%A Xhemalaj R
%A Cutuli SL
%A Tanzarella ES
%A Dell'Anna AM
%A Lombardi G
%A Cammarota F
%A Caroli A
%A Grieco DL
%A Sanguinetti M
%A Antonelli M
%A De Pascale G
%J Crit Care
%V 28
%N 1
%D 2024 Jul 12
%M 38997712
%F 19.334
%R 10.1186/s13054-024-05022-x
%X <B>BACKGROUND: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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%.<BR><B>CONCLUSIONS: </B>A decrease in serum BDG was associated with reduced mortality and a steep downslope predicted survival with high specificity in invasive candidiasis.