Infectious Diseases Unit, Department of Pediatrics, University of Turin, Regina Margherita Children's Hospital, Turin, Italy.
Infectious Diseases Unit, Istituto Giannina Gaslini, Genoa, Italy.
Mycoses. 2017 Dec;60(12):789-795. doi: 10.1111/myc.12664. Epub 2017 Aug 17.
Plasma 1,3-β-D-glucan (BDG) is indicated as a tool for early diagnosis of invasive fungal diseases (IFD). However, data on its diagnostic value are scarce in children. Therefore, definition of BDG test performance in paediatrics is needed. BDG was evaluated in children admitted to "Istituto Giannina Gaslini," Genoa, Italy, who developed clinical conditions at risk for IFD. Results were analysed for sensitivity, specificity, predictive values, likelihood ratios, accuracy, informedness and probability of missing one case by a negative test. A total of 1577 BDG determinations were performed on 255 patients (49% males, median age 5.4 years). Overall 46 IFD were diagnosed, 72% proven/probable. The test performance was evaluated for 80 pg/mL, 120 pg/mL, 200 pg/mL, 350 pg/mL, 400 pg/mL cut offs. Sensitivity was always <0.80 and specificity > 0.90 only for cut offs ≥200 pg/mL. Negative predictive value was ≥0.90 for all the cut offs evaluated, while positive predictive value resulted barely 0.50 (8% IFD prevalence). Accuracy was never >0.90, and informedness was at best 0.50. The risk of missing one IFD by a negative result was < 10%. Analyses in haemato-oncological or newborn patients did not show major differences. Detection of serum BDG does not appear a valuable adjunctive diagnostic tool for IFD in paediatrics.
血浆 1,3-β-D-葡聚糖（BDG）被认为是早期诊断侵袭性真菌病（IFD）的一种工具。然而，儿童中关于其诊断价值的数据很少。因此，需要定义儿科中 BDG 测试的性能。在意大利热那亚的“Giannina Gaslini 研究所”入院的患有 IFD 风险临床病症的儿童中评估了 BDG。分析了敏感性、特异性、预测值、似然比、准确性、信息量和漏诊一个病例的阴性测试概率。对 255 名患者的 1577 次 BDG 测定结果进行了分析（男性占 49%，中位年龄为 5.4 岁）。共诊断出 46 例 IFD，72%为确诊/可能。评估了 80 pg/mL、120 pg/mL、200 pg/mL、350 pg/mL 和 400 pg/mL 截止值的测试性能。仅当截止值≥200 pg/mL 时，敏感性始终<0.80，特异性>0.90。所有评估的截止值的阴性预测值均≥0.90，而阳性预测值仅为 0.50（IFD 患病率为 8%）。准确性从未>0.90，信息量最高为 0.50。漏诊一个 IFD 的风险<10%。在血液肿瘤或新生儿患者中的分析并未显示出重大差异。检测血清 BDG 似乎不是儿科 IFD 的一种有价值的辅助诊断工具。
