Serum β- d -glucan of critically ill patients with suspected ventilator-associated pneumonia: Preliminary observations

• Published in: Journal of critical care 2011-10, Vol.26 (5), p.536.e1-536.e9
• Main Authors: Heyland, Daren, MD, FRCPC, MSc, Jiang, Xuran, MSc, Day, Andrew G., MSc, Laverdiere, Michel, MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; beta-Glucans - blood; Biomarkers - blood; C-reactive protein; Candida; Candida - isolation & purification; Candidiasis - diagnosis; Candidiasis - mortality; Critical Care; Critical Illness; Female; Hospital Mortality; Humans; Intensive Care Units - statistics & numerical data; Interleukin-6; Lung - microbiology; Male; Middle Aged; Ontario - epidemiology; Pilot Projects; Pneumonia; Pneumonia, Ventilator-Associated - blood; Pneumonia, Ventilator-Associated - mortality; Procalcitonin; Prognosis; Prospective Studies; Risk Factors; β-d-Glucan
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2011.01.002

Abstract Background The purpose of this pilot study was to determine whether β - d -glucan (BG) was associated with Candida in the lung and risk of death in patients with suspected ventilator-associated pneumonia (VAP). Methods In a single-center observational study, we enrolled eligible adults within 24 hours of intensive care unit admission. Patients who developed suspected VAP were divided into 3 groups according to culture results. Serum BG levels and clinical outcomes were collected. Results Fifty-seven patients were included; 26 had no growth, 19 patients grew pathogenic bacteria only, and 12 patients grew only Candida. The proportion of patients with a positive BG tended to be greater in the Candida group (66.7% vs 26.3% in bacteria group vs 50.0% in culture-negative group, P = .09). The BG-positive patients were much more likely to die by day 28 than the BG-negative patients (odds ratio, 4.2; 95% confidence limits, 1.1-15.7; P = .03). Patients with both BG positivity and Candida in their lung secretions were much more likely to die compared with patients who did not. Conclusions β - d -Glucan positivity in patients with a suspected VAP may be a marker for Candida in the lung and worse outcomes. Further validation of this postulate is warranted.