He Hangyong, Ding Lin, Sun Bing, Li Fang, Zhan Qingyuan
Crit Care. 2012 Jul 27;16(4):R138. doi: 10.1186/cc11443.
Critically ill chronic obstructive pulmonary disease (COPD) patients are at particular risk of invasive pulmonary aspergillosis (IPA). Our aims were to determine whether bronchoalveolar lavage fluid (BALF) galactomannan (GM) has a higher sensitivity and specificity than serum GM or lower respiratory tract (LRT) sample culture. Furthermore, we aimed to investigate what the optimal cut-off value would be for BALF GM.
In this prospective single-center study, BALF and serum samples were collected from critically ill COPD patients on the first day of their intensive care unit admission.
Of 50 critically ill COPD patients admitted, BALF and serum samples were collected in 34 patients. According to the receiver operating characteristics (ROC) curve, an optical density (OD) ratio of 0.8 was chosen as the cut-off value for GM in BALF. Compared to serum GM and LRT Aspergillus isolation, BALF GM yield a better sensitivity, specificity, positive and negative predictive values of 88.9%, 100%, 100% and 94.4%, respectively. Areas under the ROC curve were 0.912 (95%CI, 0.733 to 0.985) for BALF GM, and 0.879 (95%CI, 0.691 to 0.972) for serum GM results from the first day of ICU admission. Pairwise comparison of ROC curves showed P = 0.738. The OD ratio of BALF GM in IPA patients were significantly higher than those of non-IPA patients (2.88 ± 2.09 versus 0.49 ± 0.19, P = 0.009), and the OD ratio of BALF GM was significantly higher than serum GM in IPA patients (2.88 ± 2.09 versus 0.87 ± 0.47, P = 0.023). Positive BALF GM was seen earlier than LRT secretion culture (1 day versus 3.8 days).
Compared to serum GM and LRT Aspergillus isolation, BALF GM seems to have a better sensitivity in the diagnosis of IPA in critically ill COPD patients. The ROC curve suggests a possible cut-off value of 0.8 for GM from BALF specimens in critically ill COPD patients.
重症慢性阻塞性肺疾病（COPD）患者发生侵袭性肺曲霉病（IPA）的风险尤其高。我们的目的是确定支气管肺泡灌洗液（BALF）半乳甘露聚糖（GM）是否比血清GM或下呼吸道（LRT）样本培养具有更高的敏感性和特异性。此外，我们旨在研究BALF GM的最佳临界值是多少。
在这项前瞻性单中心研究中，在重症COPD患者入住重症监护病房的第一天采集BALF和血清样本。
在50例入住的重症COPD患者中，34例患者采集了BALF和血清样本。根据受试者工作特征（ROC）曲线，选择光密度（OD）比值0.8作为BALF中GM的临界值。与血清GM和LRT曲霉菌分离相比，BALF GM的敏感性、特异性、阳性预测值和阴性预测值分别为88.9%、100%、100%和94.4%。入住ICU第一天，BALF GM的ROC曲线下面积为0.912（95%CI，0.733至0.985），血清GM为0.879（95%CI，0.691至0.972）。ROC曲线的成对比较显示P = 0.738。IPA患者BALF GM的OD比值显著高于非IPA患者（2.88±2.09对0.49±0.19，P = 0.009），IPA患者BALF GM的OD比值显著高于血清GM（2.88±2.09对0.87±0.47，P = 0.023）。BALF GM阳性出现的时间早于LRT分泌物培养（1天对3.8天）。
与血清GM和LRT曲霉菌分离相比，BALF GM在重症COPD患者IPA诊断中似乎具有更好的敏感性。ROC曲线表明重症COPD患者BALF标本中GM的临界值可能为0.8。
