Intensive Care Unit, Hospital Universitario de Valme, Universidad de Sevilla, Carretera de Cádiz s/n, 41014 Seville, Spain.
Intensive Care Med. 2012 Aug;38(8):1315-25. doi: 10.1007/s00134-012-2616-y. Epub 2012 Jun 30.
To assess the value of (1→3)-β-D: -glucan (BDG), Candida albicans germ tube antibody (CAGTA), C-reactive protein (CRP), and procalcitonin (PCT) levels for the diagnosis of invasive candidiasis (IC) and for differentiating Candida spp. colonization from infection in ICU patients with severe abdominal conditions (SAC).
Prospective study of 176 non-neutropenic patients, with SAC at ICU admission, and expected to stay at least 7 days. Surveillance cultures and BDG, CAGTA, CRP, and PCT levels were performed on the third day of ICU stay and twice a week for four consecutive weeks. Patients were grouped into invasive candidiasis (IC), Candida colonization, and neither colonized/nor infected. The classification and regression tree (CART) analysis was used to predict IC in colonized patients. The discriminatory ability of the obtained prediction rule was assessed by the area under the ROC curve (AUC).
The probabilities of IC were 59.3 % for the terminal node of BDG greater than 259 pg/mL and 30.8 % for BDG less than 259 pg/mL and CAGTA positivity, whereas there was a 93.9 % probability in predicting the absence of IC for BDG less than 259 pg/mL and negative CAGTA. Using a cutoff of 30 % for IC probability, the prediction rule showed 90.3 % sensitivity, 54.8 % specificity, 42.4 % positive predictive value, and 93.9 % negative predictive value with an AUC of 0.78 (95 % confidence interval 0.76-0.81). Significant differences in CRP (p = 0.411) and PCT (p = 0.179) among the studied groups were not found.
BDG with a positive test for CAGTA accurately differentiated Candida colonization from IC in patients with SAC, whereas CRP and PCT did not.
评估 1→3)-β-D-葡聚糖（BDG）、白色念珠菌芽管抗体（CAGTA）、C 反应蛋白（CRP）和降钙素原（PCT）水平在诊断侵袭性念珠菌病（IC）和区分 ICU 中患有严重腹部疾病（SAC）的患者中念珠菌定植与感染方面的价值。
这是一项前瞻性研究，纳入了 176 名非中性粒细胞减少的患者，这些患者在 ICU 入院时患有 SAC，预计至少要住院 7 天。在 ICU 住院的第 3 天以及接下来的 4 周内每周进行两次监测培养和 BDG、CAGTA、CRP 和 PCT 水平检测。患者分为侵袭性念珠菌病（IC）、念珠菌定植和非定植/未感染。使用分类回归树（CART）分析来预测定植患者中的 IC。通过 ROC 曲线下面积（AUC）评估所获得预测规则的鉴别能力。
BDG 大于 259 pg/mL 和 CAGTA 阳性的终节点的 IC 概率为 59.3%，而 BDG 小于 259 pg/mL 和 CAGTA 阴性的 IC 概率为 30.8%。BDG 小于 259 pg/mL 和 CAGTA 阴性预测 IC 不存在的概率为 93.9%。使用 IC 概率的 30%作为截断值，预测规则的敏感性为 90.3%，特异性为 54.8%，阳性预测值为 42.4%，阴性预测值为 93.9%，AUC 为 0.78（95%置信区间 0.76-0.81）。在研究组中，CRP（p=0.411）和 PCT（p=0.179）之间无显著差异。
BDG 联合 CAGTA 阳性试验可准确区分 SAC 患者中的念珠菌定植与 IC，而 CRP 和 PCT 则不行。
