Infectious Diseases Division, University of Genoa (DISSAL) and Ospedale Policlinico San Martino - IRCCS per l'Oncologia, L.go R. Benzi, 10 - 16132, Genoa, Italy.
Institute of Infectious Diseases, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.
Crit Care. 2017 Jul 10;21(1):176. doi: 10.1186/s13054-017-1763-5.
This study aimed to assess the combined performance of serum (1,3)-β-D-glucan (BDG) and procalcitonin (PCT) for the differential diagnosis between candidaemia and bacteraemia in three intensive care units (ICUs) in two large teaching hospitals in Italy.
From June 2014 to December 2015, all adult patients admitted to the ICU who had a culture-proven candidaemia or bacteraemia, as well as BDG and PCT measured closely to the time of the index culture, were included in the study. The diagnostic performance of BDG and PCT, used either separately or in combination, was assessed by calculating the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios (LR+ and LR-). Changes from pre-test probabilities to post-test probabilities of candidaemia and bacteraemia were inferred from Fagan's nomograms.
One hundred and sixty-six patients were included, 73 with candidaemia (44%) and 93 with bacteraemia (56%). When both markers indicated candidaemia (BDG ≥80 pg/ml and PCT <2 ng/ml) they showed higher PPV (96%) compared to 79% and 66% for BDG or PCT alone, respectively. When both markers indicated bacteraemia (BDG <80 pg/ml and PCT ≥2 ng/ml), their NPV for candidaemia was similar to that of BDG used alone (95% vs. 93%). Discordant BDG and PCT results (i.e. one indicating candidaemia and the other bacteraemia) only slightly altered the pre-test probabilities of the two diseases.
The combined use of PCT and BDG could be helpful in the diagnostic workflow for critically ill patients with suspected candidaemia.
本研究旨在评估血清（1,3）-β-D-葡聚糖（BDG）和降钙素原（PCT）联合检测在意大利两家大型教学医院的三个重症监护病房（ICU）中用于区分念珠菌血症和菌血症的诊断效能。
从 2014 年 6 月至 2015 年 12 月，所有 ICU 中培养确诊的念珠菌血症或菌血症的成年患者，以及在进行指数培养时密切测量的 BDG 和 PCT，都被纳入研究。通过计算灵敏度、特异性、阳性预测值（PPV）、阴性预测值（NPV）、阳性和阴性似然比（LR+和 LR-）来评估 BDG 和 PCT 单独或联合使用的诊断性能。从 Fagan 列线图推断出念珠菌血症和菌血症的预测试概率到后测试概率的变化。
共纳入 166 例患者，其中 73 例为念珠菌血症（44%），93 例为菌血症（56%）。当两种标志物均提示念珠菌血症（BDG≥80 pg/ml 和 PCT<2 ng/ml）时，其 PPV（96%）高于单独使用 BDG（79%）或 PCT（66%）。当两种标志物均提示菌血症（BDG<80 pg/ml 和 PCT≥2 ng/ml）时，其对念珠菌血症的 NPV 与单独使用 BDG 相似（95%vs.93%）。BDG 和 PCT 结果不一致（即一种提示念珠菌血症，另一种提示菌血症）仅略微改变了两种疾病的预测试概率。
联合使用 PCT 和 BDG 可能有助于对疑似念珠菌血症的重症患者的诊断流程。
