支气管肺泡灌洗液 1,3-β-D-葡聚糖水平的预后潜力。

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

机构信息

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.

出版信息

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

DOI:10.1016/j.jinf.2015.09.016

PMID:26416472

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.

摘要

目的

本研究旨在探讨支气管肺泡灌洗液（BALF）中 1,3-β-D-葡聚糖（BDG）检测的预后价值。

方法

共检测了 252 例患者的 300 份 BALF 样本中的 BDG（Fungitell（®）检测）。通过 Kaplan-Meier 分析和多变量 Cox 风险回归分析评估 BALF BDG 的预后价值。

结果

BALF 中 BDG 水平在假丝酵母菌定植的样本中明显升高（p<0.001）。BALF 采样后 90 天内共有 61/252 例患者（24.2%）死亡（BALF BDG<200pg/mL 的患者中 18.1%，BALF BDG≥200pg/mL 的患者中 32.4%）。Kaplan-Meier 分析显示，BALF BDG 水平≥200pg/mL 的患者与 BALF BDG 水平<200pg/mL 的患者相比，总体累积 90 天死亡率明显更高（对数秩检验 p=0.006，Breslow 检验 p=0.005，Tarone-Ware 检验 p=0.005）。多变量 Cox 回归分析显示，BALF BDG 水平是 90 天总体死亡率的一个强有力的预测因子，其危险比为 1.048（BALF BDG 每增加 100pg/mL）。