1,3‐ß‐D‐glucan concentrations in blood products predict false positive post‐transfusion results

Liss, Blasius; Cornely, Oliver A.; Hoffmann, Dennis; Dimitriou, Vassiliki; Wisplinghoff, Hilmar

doi:10.1111/myc.12432

Cited by 32 publications

(16 citation statements)

References 18 publications

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“…The problem is that the test is non‐specific, resulting in a very low PPV, even if we consider two consecutive positive tests and the 2.7% incidence of fusariosis in our centre, which is much higher than that observed in other regions of the globe . The low specificity of BDG has been attributed to frequent false‐positive tests related to various factors such as bacteraemia, antibiotics, gastrointestinal mucositis or surgery, and infusion of blood products . In our study, exposures to potential causes of false‐positive BDG test including bacteraemia, use of antibiotics, gastrointestinal mucositis and infusion of blood products were similar in cases and controls.…”

Section: Discussionmentioning

confidence: 80%

Performance of 1,3‐beta‐D‐glucan in the diagnosis and monitoring of invasive fusariosis

Nucci

Barreiros

Reis

et al. 2019

Mycoses

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Summary Invasive fusariosis (IF) usually presents with high fungal burden at diagnosis, and this may contribute to its high mortality rate. The use 1,3‐beta‐D‐glucan (BDG) may help to establish the diagnosis at an earlier disease stage and to monitor treatment. To evaluate the performance of BDG in the diagnosis of IF and its kinetics in relation to the outcome, we retrospectively tested serum samples of 13 cases of IF, analysed the temporal relationship between the first positive BDG test and the date of the diagnosis of IF, and the kinetics of BDG in relation to patients’ outcome. We selected 13 controls with similar underlying diseases as cases, at least two serum samples stored, and no invasive fungal disease. Twelve patients with IF had at least one positive BDG (median 4, range 1‐16). The test was positive before the diagnosis of IF in 11 of the 12 patients (91.6%), at a median of 10 days (range 1‐32). The median BDG value increased (from 109 to 316 pg/mL, P = 0.04) in patients who died by day 30, and did not change significantly (99‐101 pg/mL, P = 0.60) in survivors. Using two consecutive BDG tests, sensitivity, specificity, and positive and negative predictive values were 85%, 69%, 7% and 99%, respectively. BDG is positive in the majority of patients with IF, usually before the diagnosis, but the low positive predictive value limits its use to diagnose IF earlier. Once therapy is started, decreasing BDG values suggests treatment response.

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Section: Discussionmentioning

confidence: 80%

Performance of 1,3‐beta‐D‐glucan in the diagnosis and monitoring of invasive fusariosis

Nucci

Barreiros

Reis

et al. 2019

Mycoses

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“…Elevated BDG serum concentrations of more than 80 pg/ml have a high diagnostic accuracy to predict ICI [12, 13, 18, 33, 34]. However, the available data suggest that many ICU interventions may interfere by increasing BDG serum concentrations [11, 14, 15]. In addition, the diagnostic accuracy of BDG has been reported only for candidemia rather than ICI in general and may also depend on the fungal species [12].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, falsely increased BDG serum concentrations in the absence of ICI may be induced by several common ICU interventions. For example, concurrent bacteremia, hemodialysis membranes, administrations of blood products, and treatment with albumin or immunoglobulin products can interfere with BDG measurements [11, 14, 15]. If relevant, this type of interference would significantly reduce the clinical usability of BDG assays in critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

(1,3)-β-D-glucan-based diagnosis of invasive Candida infection versus culture-based diagnosis in patients with sepsis and with an increased risk of invasive Candida infection (CandiSep): study protocol for a randomized controlled trial

Bloos

Held

Brillinger

et al. 2018

Trials

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BackgroundThe time to diagnosis of invasive Candida infection (ICI) is often too long to initiate timely antifungal therapy in patients with sepsis. Elevated serum (1,3)-β-D-glucan (BDG) concentrations have a high diagnostic sensitivity for detecting ICI. However, the clinical significance of elevated BDG concentrations is unclear in critically ill patients. The goal of this study is to investigate whether measurement of BDG in patients with sepsis and a high risk for ICI can be used to decrease the time to empiric antifungal therapy and thus, increase survival.Methods/designThis prospective multicenter open randomized controlled trial is being conducted in 19 German intensive care units. All adult patients with severe sepsis or septic shock and an increased risk for ICI are eligible for enrolment. Risk factors are total parenteral nutrition, previous abdominal surgery, previous antimicrobial therapy, and renal replacement therapy. Patients with proven ICI or those already treated with systemic antifungal substances are excluded. Patients are allocated to a BDG or standard care group. The standard care group receives targeted antifungal therapy as necessary. In the BDG group, BDG serum samples are taken after randomization and 24 h later. Antifungal therapy is initiated if BDG is ≥80 pg/ml in at least one sample. We plan to enroll 312 patients. The primary outcome is 28-day mortality. Other outcomes include antifungal-free survival within 28 days after enrolment, time to antifungal therapy, and the diagnostic performance of BDG compared to other laboratory tests for early ICI diagnosis. The statistical analysis will be performed according to the intent-to-treat principle.DiscussionBecause of the high risk of death, American guidelines recommend empiric antifungal therapy in sepsis patients with a high risk of ICI despite the limited evidence for such a recommendation. In contrast, empiric antifungal therapy is not recommended by European guidelines. BDG may offer a way out of this dilemma since BDG potentially identifies patients in need of early antifungals. However, the evidence for such an approach is inconclusive. This clinical study will generate solid evidence for health-care providers and authors of guidelines for the use of BDG in critically ill patients.Trial registrationClinicaltrials.gov, NCT02734550. Registered 12 April 2016.

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“…Timely diagnosis is important to allow treatment early in the course of disease . However, there is uncertainty about the ideal diagnostic approach: clinicians may be reluctant to follow an aggressive diagnostic algorithm in a very sick patient, laboratory‐based mycologists may not receive the appropriate samples, and pathologists may not receive any sample at all, since invasive procedures are avoided. At first glance it appears obvious to choose a triazole for first‐line treatment, however, most patients at risk will already receive triazole prophylaxis.…”

Section: Introductionmentioning

confidence: 99%

EQUAL Aspergillosis Score 2018: An ECMM score derived from current guidelines to measure QUALity of the clinical management of invasive pulmonary aspergillosis

Cornely

Köehler

Arenz

et al. 2018

Mycoses

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Invasive pulmonary aspergillosis is a serious threat to immunocompromised and critical care patients. Recent detailed guidelines and treatment algorithms lead microbiologists and clinicians in diagnosis and treatment of invasive aspergillosis. Currently, there is no tool available that allows to measure guideline adherence. To develop such a tool, we reviewed current guidelines provided by five scientific societies (European Society for Clinical Microbiology and Infectious Diseases, European Confederation of Medical Mycology, European Respiratory Society, Infectious Diseases Society of America (IDSA), and Infectious Diseases Working Party of the German Society for Hematology and Medical Oncology) and selected the strongest recommendations for management as key components for our scoring tool. We integrated diagnostic measures (chest computed tomography, bronchoalveolar lavage with galactomannan, fungal culture, fungal polymerase chain reaction analysis, species identification, susceptibility testing, histology with silver stain, Periodic acid-Schiff staining, and molecular diagnostics), treatment (antifungal choice and therapeutic drug monitoring), and follow-up computed tomography. The EQUAL Aspergillosis Score 2018 aggregates and weighs the components and provides a tool to support antifungal stewardship and to quantify guideline adherence.

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1,3‐ß‐D‐glucan concentrations in blood products predict false positive post‐transfusion results

Cited by 32 publications

References 18 publications

Performance of 1,3‐beta‐D‐glucan in the diagnosis and monitoring of invasive fusariosis

Performance of 1,3‐beta‐D‐glucan in the diagnosis and monitoring of invasive fusariosis

(1,3)-β-D-glucan-based diagnosis of invasive Candida infection versus culture-based diagnosis in patients with sepsis and with an increased risk of invasive Candida infection (CandiSep): study protocol for a randomized controlled trial

EQUAL Aspergillosis Score 2018: An ECMM score derived from current guidelines to measure QUALity of the clinical management of invasive pulmonary aspergillosis

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