Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Front Cell Infect Microbiol. 2022 Mar 25;12:861866. doi: 10.3389/fcimb.2022.861866. eCollection 2022.
The modified International Society for Human and Animal Mycology (ISHAM) allergic bronchopulmonary aspergillosis (ABPA) working group (AWG) criteria lists up to five components for diagnosing ABPA in asthmatics. Whether eliminating specific components of the existing criteria would have the same diagnostic utility as the original remains unknown.
To evaluate the performance of several simplified criteria for diagnosing ABPA.
We compared the performance of seven new criteria (after excluding or modifying one or more of the components of the ISHAM-AWG criteria) with the modified ISHAM-AWG criteria in asthmatic subjects using latent class analysis (LCA). We also tested the performance of the newer criteria using accuracy measures against a multidisciplinary team (MDT) diagnosis of ABPA. We considered the diagnostic accuracy of the newer criteria to be acceptable if the correct classification and false-negative rates were >95% and <5%, respectively, on an MDT evaluation.
We analyzed data from 543 asthmatic subjects (58.8% women; mean age, 36.8 years). Using LCA, the sensitivity of the -specific IgE-based criteria ranged from 92-99%, while the specificity varied between 92% and 100%. The MDT diagnosed ABPA in 106 (19.5%) subjects. Using MDT as the reference standard, the correct classification and false-negative rates were >95% for three of the seven and <5% for four of the seven newer criteria.
We found several of the newly developed criteria to perform, like the modified ISHAM-AWG criteria, for diagnosing ABPA complicating asthma. A prospective study in current clinical algorithms is required for validating our observations.
改良的国际人类和动物真菌学会（ISHAM）变应性支气管肺曲霉病（ABPA）工作组（AWG）标准列出了多达五个用于诊断哮喘患者 ABPA 的组成部分。目前尚不清楚是否消除现有标准的特定组成部分是否具有与原始标准相同的诊断效用。
评估几种简化的 ABPA 诊断标准的性能。
我们使用潜在类别分析（LCA）比较了 7 种新的标准（在排除或修改 ISHAM-AWG 标准的一个或多个组成部分后）与改良的 ISHAM-AWG 标准在哮喘患者中的表现。我们还使用针对多学科团队（MDT）ABPA 诊断的准确性指标测试了较新标准的性能。我们认为，如果新的标准在 MDT 评估中的正确分类和假阴性率分别>95%和<5%，则可以接受其诊断准确性。
我们分析了 543 名哮喘患者（58.8%为女性；平均年龄 36.8 岁）的数据。使用 LCA，基于特异性 IgE 的标准的敏感性范围为 92%-99%，而特异性在 92%-100%之间变化。MDT 诊断 106 名（19.5%）患者患有 ABPA。使用 MDT 作为参考标准，7 种新的标准中的 3 种的正确分类和假阴性率>95%，而 7 种新的标准中的 4 种<5%。
我们发现几种新开发的标准与改良的 ISHAM-AWG 标准一样，可用于诊断并发哮喘的 ABPA。需要在当前的临床算法中进行前瞻性研究来验证我们的观察结果。
