Rozaliyani Anna, Sedono Rudyanto, Jusuf Anwar, Rumende Cleopas M, Aniwidyaningsih Wahju, Burhan Erlina, Prasenohadi Prasenohadi, Handayani Diah, Yunihastuti Evy, Siagian Forman E, Jayusman Achmad M, Rusli Adria, Sungkar Saleha, Prihartono Joedo, Hagen Ferry, Meis Jacques F, Wahyuningsih Retno
Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. E-mail.
Saudi Med J. 2019 Feb;40(2):140-146. doi: 10.15537/smj.2019.2.22940.
To improve the quality of invasive pulmonary aspergillosis (IPA) management for intensive care unit (ICU) patients using a practical diagnostic scoring model.
This nested case-control study aimed to determine the incidence of IPA in 405 ICU patients, between July 2012 and June 2014, at 6 hospitals in Jakarta, Indonesia. Phenotypic identifications and galactomannan (GM) tests of sera and lung excreta were performed in mycology laboratory, Parasitology Department, Faculty of Medicine, Universitas Indonesia in Jakarta, Indonesia.
The incidence of IPA in the ICUs was 7.7% (31 of 405 patients). A scoring model used for IPA diagnosis showed 4 variables as the most potential risk factors: lung excreta GM index (score 2), solid organ malignancy (score 2), pulmonary tuberculosis (score 2), and systemic corticosteroids (score 1). Patients were included in a high-risk group if their score was greater than 2, and in a low-risk group if their score was less than 2.
This study provides a novel diagnosis scoring model to predict IPA in ICU patients. Using this model, a more rapid diagnosis and treatment of IPA may be possible. The application of the diagnosis scoring should be preceded by specified pre-requisites.
使用一种实用的诊断评分模型提高重症监护病房（ICU）患者侵袭性肺曲霉病（IPA）的管理质量。
这项巢式病例对照研究旨在确定2012年7月至2014年6月期间印度尼西亚雅加达6家医院405例ICU患者中IPA的发病率。在印度尼西亚雅加达印度尼西亚大学医学院寄生虫学系的真菌学实验室对血清和肺排泄物进行表型鉴定和半乳甘露聚糖（GM）检测。
ICU中IPA的发病率为7.7%（405例患者中的31例）。用于IPA诊断的评分模型显示4个变量为最潜在的危险因素：肺排泄物GM指数（评分2）、实体器官恶性肿瘤（评分2）、肺结核（评分2）和全身用皮质类固醇（评分1）。评分大于2的患者被纳入高危组，评分小于2的患者被纳入低危组。
本研究提供了一种预测ICU患者IPA的新型诊断评分模型。使用该模型，可能实现对IPA更快速的诊断和治疗。诊断评分的应用应以特定的先决条件为前提。
