Mercier Toine, Wera Joachim, Chai Louis Y A, Lagrou Katrien, Maertens Johan
KU Leuven, Department of Microbiology, Immunology and Transplantation, 3000 Leuven, Belgium.
Department of Hematology, University Hospitals Leuven, 3000 Leuven, Belgium.
J Clin Med. 2020 Feb 24;9(2):610. doi: 10.3390/jcm9020610.
In invasive aspergillosis (IA), an early and adequate assessment of the response to the initial antifungal therapy remains problematic. We retrospectively analyzed 206 hematology patients with proven or probable IA, and collected serial serum galactomannan (sGM) values and survival status through week 6 and week 12. We created a model for survival at week 6 based on the sGM taken at baseline and on early sGM kinetics. This resulted in a rule predicting that patients with a baseline sGM index >1.4, who failed to lower that index to <0.5 after one week, had a mortality rate of 48.1% at week 6. Conversely, patients presenting with a baseline sGM index ≤1.4 that obtained a negative sGM (<0.5) after one week, had a mortality that was almost five times lower at only 10.1% by week 6. These findings were confirmed in an external cohort from an independent prospective study. In conclusion, sGM kinetics correlate well with treatment outcomes in hematology patients with IA. We present a rule which is easy to use at the bedside and has good accuracy in predicting week 6 survival.
在侵袭性曲霉病（IA）中，对初始抗真菌治疗反应的早期充分评估仍然存在问题。我们回顾性分析了206例确诊或疑似IA的血液学患者，并收集了第6周和第12周的系列血清半乳甘露聚糖（sGM）值和生存状态。我们基于基线时的sGM以及早期sGM动力学创建了一个第6周生存模型。这得出了一条规则，即基线sGM指数>1.4且在一周后未能将该指数降至<0.5的患者，在第6周的死亡率为48.1%。相反，基线sGM指数≤1.4且在一周后sGM呈阴性（<0.5）的患者，到第6周时死亡率低近五倍，仅为10.1%。这些发现在一项独立前瞻性研究的外部队列中得到了证实。总之，sGM动力学与IA血液学患者的治疗结果密切相关。我们提出了一条易于在床边使用且在预测第6周生存方面具有良好准确性的规则。
