Prognostic potential of 1,3-beta-d-glucan levels in bronchoalveolar lavage fluid samples

Frederike M J Reischies; Juergen Prattes; Florian Prüller; Susanne Eigl; Agnes List; Albert Wölfler; Walter Buzina; Ines Zollner-Schwetz; Thomas Valentin; Jasmin Rabensteiner; Holger Flick; Robert Krause; Reinhard B Raggam; Martin Hoenigl

doi:10.1016/j.jinf.2015.09.016

Prognostic potential of 1,3-beta-d-glucan levels in bronchoalveolar lavage fluid samples

J Infect. 2016 Jan;72(1):29-35. doi: 10.1016/j.jinf.2015.09.016. Epub 2015 Sep 28.

Affiliations

¹ Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
² Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
³ Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
⁴ Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
⁵ Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria.
⁶ Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria. Electronic address: reinhard.raggam@medunigraz.at.
⁷ Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria; Division of Infectious Diseases, Department of Medicine, University of California, San Diego, USA. Electronic address: martin.hoenigl@medunigraz.at.

PMID: 26416472
DOI: 10.1016/j.jinf.2015.09.016

Abstract

Objectives: The objective of this study was to investigate the prognostic potential of 1,3-beta-d-glucan (BDG) testing in bronchoalveolar lavage fluid (BALF) samples.

Methods: A total of 300 BALF samples from 252 patients were investigated for BDG (Fungitell(®) assay). Prognostic potential of BALF BDG was evaluated by using: i.) Kaplan-Meier analysis, and ii.) multivariable Cox hazard regression analyses.

Results: BALF BDG levels were found to be significantly higher in samples with Candida spp. colonization (p < 0.001). A total of 61/252 patients (24.2%) died within 90-days of BALF sampling (18.1% of patients with BALF BDG <200 pg/mL, 32.4% with BALF BDG ≥200 pg/mL). Kaplan-Meier analysis revealed that overall cumulative 90-day mortality was significantly higher in those with BALF BDG levels ≥200 pg/mL when compared to those with levels <200 pg/mL (log-rank p = 0.006, Breslow p = 0.005 and Tarone-Ware p = 0.005). The multivariable Cox regression analysis showed that BALF BDG levels were a strong predictor of 90-day overall mortality, with a hazard ratio of 1.048 (per 100 pg/mL increase of BALF BDG).

Conclusion: False positive BALF BDG results in the presence of Candida spp. colonization of the lower respiratory tract may explain the limited diagnostic potential of BALF BDG testing. In contrast, prognostic potential of BALF BDG may be promising.

Keywords: 30-Day; 90-Day; BAL; BDG; ICU; Mortality; Prognostic; Survival.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Bronchoalveolar Lavage Fluid / chemistry*
Candidiasis, Invasive / diagnosis*
Candidiasis, Invasive / mortality*
Cohort Studies
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Prognosis
Pulmonary Aspergillosis / diagnosis*
Pulmonary Aspergillosis / mortality*
Risk Factors
Young Adult
beta-Glucans / analysis*

Substances

beta-Glucans