Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
Division of Infectious Diseases, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
Med Mycol. 2024 Aug 2;62(8). doi: 10.1093/mmy/myae071.
We evaluated the diagnostic performance of the β-d-glucan (BDG) test (Beijing Gold Mountain River Tech) in diagnosing invasive fungal disease (IFD) and its variations among patients with different risks. Patients ≥18 years old who underwent a serum BDG test (positive cutoff value >80 pg/ml) from April 2017 through May 2018 were collected consecutively. Patients were classified into three groups: group 1, patients with host factors as defined by the prior 2008 European Organization for Research and Treatment (EORTC) criteria; group 2, those with extended host factors in 2020 EORTC criteria; and group 3, those without any risk factor mentioned in the criteria. IFD was defined by 2020 EORTC criteria, but BDG was not considered. Diagnostic performance of the serum BDG test was measured by the area under the curve (AUC) of the receiver-operating characteristic curve. Among 469 patients, 15.4% (72/469) were diagnosed with IFD (48/191 [25.1%], 14/144 [9.7%], and 10/134 [7.5%] in groups 1, 2, and 3, respectively). The BDG assay showed fair performance (AUC 0.748 [95% CI: 0.688-0.810]). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 77.8%, 60.7%, 26.4%, and 93.8%, respectively. PPV was higher in group 1, and NPV was higher in group 3. Additionally, diagnostic odds ratios were 6.73, 2.88, and 5.92 in groups 1, 2, and 3. Immunosuppressant use, non-IFD/Candida colonization, and central venous catheter were associated with false positivity. Clinicians should cautiously interpret the BDG assay, considering the various diagnostic performances depending on the different levels of risk.
我们评估了β-D-葡聚糖（BDG）检测（北京金山川科技）在诊断侵袭性真菌病（IFD）及其在不同风险患者中的变化中的诊断性能。从 2017 年 4 月至 2018 年 5 月，连续收集了接受血清 BDG 检测（阳性截断值>80pg/ml）的年龄≥18 岁的患者。患者分为三组：组 1，符合 2008 年欧洲研究与治疗组织（EORTC）标准的宿主因素患者；组 2，符合 2020 年 EORTC 标准的扩展宿主因素患者；组 3，无标准中提到的任何危险因素的患者。IFD 按 2020 年 EORTC 标准定义，但不考虑 BDG。血清 BDG 检测的诊断性能通过受试者工作特征曲线的曲线下面积（AUC）来衡量。在 469 例患者中，15.4%（72/469）诊断为 IFD（48/191[25.1%]、14/144[9.7%]和 10/134[7.5%]分别在组 1、2 和 3 中）。BDG 检测表现出良好的性能（AUC 0.748[95%CI：0.688-0.810]）。敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 77.8%、60.7%、26.4%和 93.8%。PPV 在组 1 中较高，NPV 在组 3 中较高。此外，组 1、2 和 3 的诊断优势比分别为 6.73、2.88 和 5.92。免疫抑制剂使用、非 IFD/Candida 定植和中心静脉导管与假阳性相关。临床医生应根据不同的风险水平，谨慎解释 BDG 检测结果，考虑到不同的诊断性能。
