Existing tests vs. novel non-invasive assays for detection of invasive aspergillosis in patients with respiratory diseases

Although existing mycological tests (bronchoalveolar lavage [BAL] galactomannan [GM], serum GM, serum (1,3)-β-D-glucan [BDG], and fungal culture) are widely used for diagnosing invasive pulmonary aspergillosis (IPA) in non-hematological patients with respiratory diseases, their clinical utility in t...

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Published in:Chinese medical journal 2022-07, Vol.135 (13), p.1545-1554
Main Authors: Xiao, Wei, Du, Longyi, Cai, Linli, Miao, Tiwei, Mao, Bing, Wen, Fuqiang, Gibson, Peter Gerard, Gong, Deying, Zeng, Yan, Kang, Mei, Du, Xinmiao, Qu, Junyan, Wang, Yan, Liu, Xuemei, Feng, Ruizhi, Fu, Juanjuan
Format: Article
Language:English
Subjects:
Accuracy
Aspergillosis
Biomarkers
Chronic obstructive pulmonary disease
Clinical medicine
Consent
Diagnostic tests
Fungal infections
Hematology
Hospitals
Immunocompetence
Laboratories
Lung diseases
Original
Patients
Respiratory diseases
Sample size
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Summary:Although existing mycological tests (bronchoalveolar lavage [BAL] galactomannan [GM], serum GM, serum (1,3)-β-D-glucan [BDG], and fungal culture) are widely used for diagnosing invasive pulmonary aspergillosis (IPA) in non-hematological patients with respiratory diseases, their clinical utility in this large population is actually unclear. We aimed to resolve this clinical uncertainty by evaluating the diagnostic accuracy and utility of existing tests and explore the efficacy of novel sputum-based Aspergillus assays. Existing tests were assessed in a prospective and consecutive cohort of patients with respiratory diseases in West China Hospital between 2016 and 2019 while novel sputum assays (especially sputum GM and Aspergillus-specific lateral-flow device [LFD]) in a case-controlled subcohort. IPA was defined according to the modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Sensitivity and specificity were computed for each test and receiver operating characteristic (ROC) curve analysis was performed. The entire cohort included 3530 admissions (proven/probable IPA = 66, no IPA = 3464) and the subcohort included 127 admissions (proven/probable IPA = 38, no IPA = 89). Sensitivity of BAL GM (≥1.0 optical density index [ODI]: 86% [24/28]) was substantially higher than that of serum GM (≥0.5 ODI: 38% [39/102]) ( χ2  = 19.83, P   <  0.001), serum BDG (≥70 pg/mL: 33% [31/95]) ( χ2  = 24.65, P  
ISSN:2542-5641
0366-6999
2542-5641
DOI:10.1097/CM9.0000000000002050