Value of β-D-glucan and Candida albicans germ tube antibody for discriminating between Candida colonization and invasive candidiasis in patients with severe abdominal conditions
Value of β-D-glucan and Candida albicans germ tube antibody for discriminating between Candida colonization and invasive candidiasis in patients with severe abdominal conditions
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DOI：
10.1007/s00134-012-2616-y
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发表时间：
2012-08-01
影响因子：
38.9
通讯作者：
Farinas, Osvaldo
中科院分区：
文献类型：
--
作者：
Leon, Cristobal;Ruiz-Santana, Sergio;Farinas, Osvaldo
目的探讨(1 - bbb3)- β -d-葡聚糖（BDG）、白色念珠菌生殖管抗体（CAGTA）、c反应蛋白（CRP）和降钙素原（PCT）水平在重症腹腔疾病（SAC） ICU患者侵袭性念珠菌病（IC）诊断和假丝酵母定植与感染鉴别中的价值。前瞻性研究纳入176例非中性粒细胞减少患者，在ICU入院时伴有SAC，预计住院至少7天。监测培养及BDG、CAGTA、CRP、PCT水平于ICU住院第3天进行，每周2次，连续4周。患者分为侵袭性念珠菌病（IC），念珠菌定植和未定植/未感染。分类和回归树（CART）分析用于预测定植患者的IC。用ROC曲线下面积（AUC）评价所得预测规则的判别能力。对于BDG≥259 pg/mL和CAGTA阳性的终末淋巴结，IC的概率为59.3%，对于BDG < 259 pg/mL和CAGTA阳性的终末淋巴结，IC的概率为30.8%，而对于BDG < 259 pg/mL和CAGTA阴性的终末淋巴结，IC的预测概率为93.9%。以30%的IC概率为截止值，预测规则的敏感性为90.3%，特异性为54.8%，阳性预测值为42.4%，阴性预测值为93.9%，AUC为0.78（95%置信区间为0.76 ~ 0.81）。CRP （p = 0.411）和PCT （p = 0.179）各组间无显著差异。CAGTA阳性的BDG能准确区分SAC患者的念珠菌定殖和IC，而CRP和PCT则不能。
To assess the value of (1 -> 3)-beta-d-glucan (BDG), Candida albicans germ tube antibody (CAGTA), C-reactive protein (CRP), and procalcitonin (PCT) levels for the diagnosis of invasive candidiasis (IC) and for differentiating Candida spp. colonization from infection in ICU patients with severe abdominal conditions (SAC).Prospective study of 176 non-neutropenic patients, with SAC at ICU admission, and expected to stay at least 7 days. Surveillance cultures and BDG, CAGTA, CRP, and PCT levels were performed on the third day of ICU stay and twice a week for four consecutive weeks. Patients were grouped into invasive candidiasis (IC), Candida colonization, and neither colonized/nor infected. The classification and regression tree (CART) analysis was used to predict IC in colonized patients. The discriminatory ability of the obtained prediction rule was assessed by the area under the ROC curve (AUC).The probabilities of IC were 59.3 % for the terminal node of BDG greater than 259 pg/mL and 30.8 % for BDG less than 259 pg/mL and CAGTA positivity, whereas there was a 93.9 % probability in predicting the absence of IC for BDG less than 259 pg/mL and negative CAGTA. Using a cutoff of 30 % for IC probability, the prediction rule showed 90.3 % sensitivity, 54.8 % specificity, 42.4 % positive predictive value, and 93.9 % negative predictive value with an AUC of 0.78 (95 % confidence interval 0.76-0.81). Significant differences in CRP (p = 0.411) and PCT (p = 0.179) among the studied groups were not found.BDG with a positive test for CAGTA accurately differentiated Candida colonization from IC in patients with SAC, whereas CRP and PCT did not.