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

引用

Chinese Medical Journal 2022年第13期135卷 1545-1554页

作者： Wei Xiao Longyi Du Linli Cai Tiwei Miao Bing Mao Fuqiang Wen Peter Gerard Gibso Deying Gong Yan Zeng Mei Kang Xinmiao Du Junyan Qu Yan Wang Xuemei Liu Ruizhi Feng Juanjuan Fu Respiratory Group Department of Integrated Traditional Chinese and Western MedicineWest China Hospital of Sichuan UniversityChengduSichuan 610041China Divison of Pulmonary Diseases State Key Laboratory of BiotherapyWest China Hospital of Sichuan UniversityChengduSichuan 610093China West China School of Medicine Sichuan UniversityChengduSichuan 610041China Department of Respiratory and Critical Care Medicine West China Hospital of Sichuan UniversityChengduSichuan 610041China priority Research Centre for Healthy Lungs The University of NewcastleNewcastleNSW 2305Australia Priority Research Centre for Asthma and Respiratory Diseases Hunter Medical Research InstituteNewcastleNSW 2305Australia Department of Respiratory and Sleep Medicine John Hunter HospitalNewcastleNSW 2305Australia Laboratory of Anesthesia and Critical Care Medicine Translational Neuroscience CenterWest China Hospital of Sichuan UniversityChengduSichuan 610093China Department of Pneumology Pidu District of Traditional Chinese MedicineThe Third Aflated Hospital of Chengdu University of Traditional Chinese MedicineChengduSichuan 611730China Department of Laboratory Medicine West China Hospital of Sichuan UniverstyChengduSichuan 610041China Center of Infectious Disease West China Hospital of Sichuan UniversityChengduSichuan 610041China Research Core Failty West China Hospital of Sichuan UniversitChengduSichuan 610093China.

Background: 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-basedAspergillus ***: 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 andAspergillus-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 ***: 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]) (χ^(2)=19.83,P<0.001), serum BDG (≥70 pg/mL: 33% [31/95]) (χ^(2)=24.65,P<0.001), and fungal culture (33% [84/253]) (χ^(2)=29.38,P<0.001). Specificity varied between BAL GM (≥1.0 ODI: 94% [377/402]), serum GM (≥0.5 ODI: 95% [2130/2248]), BDG (89% [1878/2106]), and culture (98% [4936/5055]). Sputum GM (≥2.0 ODI) had similar sensitivity (84% [32/38]) (Fisher’s exactP=1.000) to and slightly lower specificity (87% [77/89]) (χ^(2)=5.52,P=0.019) than BAL GM (≥1.0 ODI). Area under the ROC curve values were comparable between sputum GM (0.883 [0.812-0.953]) and BAL GM (0.901 [0.824-0.977]) (P=0.734). Sputu

关键词： Invasive pulmonary aspergillosis Sputum Bronchoalveolar lavage Galactomannan lateral-flow device

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