Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
Department of Hematology, University Hospitals Leuven, Leuven, Belgium.
Crit Care. 2020 Nov 10;24(1):642. doi: 10.1186/s13054-020-03367-7.
Invasive pulmonary aspergillosis (IPA) is an increasingly recognized complication in intensive care unit (ICU) patients, especially those with influenza, cirrhosis, chronic obstructive pulmonary disease, and other diseases. The diagnosis can be challenging, especially in the ICU, where clinical symptoms as well as imaging are mostly nonspecific. Recently, Aspergillus lateral flow tests were developed to decrease the time to diagnosis of IPA. Several studies have shown promising results in bronchoalveolar lavage fluid (BALf) from hematology patients. We therefore evaluated a new lateral flow test for IPA in ICU patients.
Using left-over BALf from adult ICU patients in two university hospitals, we studied the performance of the Aspergillus galactomannan lateral flow assay (LFA) by IMMY (Norman, OK, USA). Patients were classified according to the 2008 EORTC-MSG definitions, the AspICU criteria, and the modified AspICU criteria, which incorporate galactomannan results. These internationally recognized consensus definitions for the diagnosis of IPA incorporate patient characteristics, microbiology and radiology. The LFA was read out visually and with a digital reader by researchers blinded to the final clinical diagnosis and IPA classification.
We included 178 patients, of which 55 were classified as cases (6 cases of proven and 26 cases of probable IPA according to the EORTC-MSG definitions, and an additional 23 cases according to the modified AspICU criteria). Depending on the definitions used, the sensitivity of the LFA was 0.88-0.94, the specificity was 0.81, and the area under the ROC curve 0.90-0.94, indicating good overall test performance.
In ICU patients, the LFA performed well on BALf and can be used as a rapid screening test while waiting for other microbiological results.
侵袭性肺曲霉病（IPA）是重症监护病房（ICU）患者日益认识到的并发症，尤其是流感、肝硬化、慢性阻塞性肺疾病等疾病患者。诊断具有挑战性，特别是在 ICU 中，临床症状和影像学表现大多是非特异性的。最近，开发了曲霉侧向流动检测以减少 IPA 诊断时间。几项研究表明，在血液科患者的支气管肺泡灌洗液（BALf）中该检测具有良好的效果。因此，我们评估了用于 ICU 患者的新型 IPA 侧向流动检测。
我们使用两所大学医院的成人 ICU 患者的剩余 BALf 来研究 IMMY（美国诺曼）公司的曲霉半乳甘露聚糖侧向流动检测（LFA）的性能。根据 2008 年 EORTC-MSG 定义、AspICU 标准和包含半乳甘露聚糖结果的改良 AspICU 标准，对患者进行分类。这些 IPA 诊断的国际公认共识定义包含了患者特征、微生物学和影像学。LFA 由研究人员通过肉眼和数字读取器进行读取，研究人员对最终临床诊断和 IPA 分类一无所知。
我们纳入了 178 名患者，其中 55 名被归类为病例（根据 EORTC-MSG 定义，有 6 例确诊和 26 例可能 IPA，根据改良 AspICU 标准则有另外 23 例）。根据使用的定义，LFA 的灵敏度为 0.88-0.94，特异性为 0.81，ROC 曲线下面积为 0.90-0.94，表明总体测试性能良好。
在 ICU 患者中，LFA 在 BALf 上表现良好，可作为等待其他微生物学结果时的快速筛选检测。
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