Bronchoalveolar lavage fluid and serum 1,3-beta-d-glucan testing for invasive pulmonary aspergillosis diagnosis in hematological patients: the role of factors affecting assay performance

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Authors	WEINBERGEROVÁ Barbora KABUT Tomáš KOCMANOVÁ Iva LENGEROVÁ Martina POSPÍŠIL Zdeněk KRÁL Zdeněk MAYER Jiří
Year of publication	2020
Type	Article in Periodical
Magazine / Source	Scientific Reports
MU Faculty or unit	Faculty of Medicine
Citation
web	https://www.nature.com/articles/s41598-020-75132-3
Doi	http://dx.doi.org/10.1038/s41598-020-75132-3
Keywords	beta-D-glucan; bronchoalveolar lavage fluid; serum; invasive pulmonary aspergillosis; hematological malignancy
Attached files	Weinbergerova_SciRep_2020.pdf
Description	Invasive fungal disease (IFD) early diagnosis improves hematological patient survival. Non-culture-based methods may reduce diagnostic time to identify IFD. As complex data on the value of 1,3-beta -d-glucan (BDG) from bronchoalveolar lavage fluid (BALF) compared to serum for the most frequent invasive pulmonary aspergillosis (IPA) diagnosis are scarce, particularly including evaluation of potential factors adversely affecting BDG assay, we provided prospective single-center analysis evaluating 172 episodes of pulmonary infiltrates with BDG detection in BALF and serum samples collected in parallel among hematological patients from 2006 to 2015. Proven and probable IPA were documented in 13.4% of the episodes. Sensitivity (SEN), specificity (SPE), positive and negative predictive value (PPV; NPV), and diagnostic odds ratio (DOR) of the BDG assay using standard (80 pg/ml) cut-off for BALF were: 56.5%; 83.2%; 34.2%; 92.5%, and 6.5, respectively, and for serum were: 56.5%; 82.6%; 33.3%; 92.5%, and 6.2, respectively. The same BDG assay parameters employing a calculated optimal cut-off for BALF (39 pg/ml) were: 78.3%; 72.5%; 30.5%; 95.6%, and 9.5, respectively; and for serum (40 pg/ml) were: 73.9%; 69.1%; 27.0%; 94.5%, and 6.3, respectively. While identifying acceptable SEN, SPE, and DOR, yet low PPV of both BALF and serum BDG assay for IPA diagnosis, neither the combination of both materials nor the new optimal BDG cut-off led to significant test quality improvement. Absolute neutrophil count and aspirated BALF volume with a significant trend affected BDG assay performance. The BDG test did not outperform galactomannan assay.
Related projects:	Nové přístupy ve výzkumu, diagnostice a terapii hematologických malignit VII Český národní uzel Evropské sítě infrastruktur klinického výzkumu (CZECRIN)