Raggam Reinhard B, Fischbach Lara M L, Prattes Juergen, Duettmann Wiebke, Eigl Susanne, Reischies Frederike, Wölfler Albert, Rabensteiner Jasmin, Prueller Florian, Krause Robert, Hoenigl Martin
Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.
Mycoses. 2015 Jul;58(7):394-8. doi: 10.1111/myc.12328. Epub 2015 May 11.
Serum 1,3-beta-d-glucan (BDG) testing is an established diagnostic marker for invasive fungal infections (IFI) among patients with haematological malignancies. In contrast limited data exist regarding the application of urine BDG testing. Same-day midstream urine and serum screening samples were collected in adult patients with underlying haematological malignancies. A total of 80 urine samples from 46 patients were investigated: Twenty-six had positive corresponding serum BDG >120 pg ml(-1), 27 intermediate (60-80 pg ml(-1)), and 27 negative serum BDG (<25 pg ml(-1)). A significant positive correlation between BDG in serum and urine samples was observed (P = 0.025; r = 0.252). Sensitivity, specificity, positive predictive value and negative predictive value (compared with same-day serum results) were: 42%, 76%, 46%, 73% when using an 80 pg ml(-1) urine cut-off, and 35%, 96%, 82%, 75% for a 250 pg ml(-1) cut-off. Urine BDG seemed to be higher in samples obtained from patients with probable IFI (n = 13, median 145, IQR 22-253) compared to those from patients without IFI (n = 56, median 24, IQR 15-88) but the difference was not significant (P = 0.069). Overall correlation of same-day urine BDG and serum BDG was moderate. However, urine BDG testing may warrant further investigation in larger studies, as high-positive urine results correlated with high-positive corresponding serum levels and clinical performance was comparable to serum BDG.
血清1,3-β-D-葡聚糖（BDG）检测是血液系统恶性肿瘤患者侵袭性真菌感染（IFI）的一种既定诊断标志物。相比之下，关于尿液BDG检测应用的数据有限。收集了患有潜在血液系统恶性肿瘤的成年患者的同日中段尿和血清筛查样本。共对46例患者的80份尿液样本进行了研究：26例患者相应血清BDG>120 pg/ml呈阳性，27例为中度阳性（60 - 80 pg/ml），27例血清BDG阴性（<25 pg/ml）。观察到血清和尿液样本中的BDG之间存在显著正相关（P = 0.025；r = 0.252）。（与同日血清结果相比）敏感性、特异性、阳性预测值和阴性预测值分别为：当尿液临界值为80 pg/ml时，分别为42%、76%、46%、73%；当临界值为250 pg/ml时，分别为35%、96%、82%、75%。与无IFI的患者（n = 56，中位数24，四分位间距15 - 88）相比，疑似IFI患者（n = 13，中位数145，四分位间距22 - 253）的尿液样本中BDG似乎更高，但差异不显著（P = 0.069）。同日尿液BDG和血清BDG的总体相关性为中等。然而，尿液BDG检测可能值得在更大规模的研究中进一步调查，因为尿液高阳性结果与相应血清高水平相关，且临床表现与血清BDG相当。
