-D-Glucan Assay for the Diagnosis of Invasive Fungal Infections: A Meta-analysis

Abstract

We aimed to assess the accuracy of measuring serum or plasma (1→3)-β-D-glucan (BDG) for the diagnosis of invasive fungal infections (IFIs) by means of a meta-analysis of relevant studies. We searched in bibliographic databases for relevant cohort or case-control studies. We primarily compared BDG between patients with proven or probable IFIs (excluding Pneumocystis jirovecii infections), according to the criteria of the European Organization for Research and Treatment of Cancer/Mycoses Study Group or similar criteria, and patients without IFIs (excluding healthy individuals as controls). A total of 2979 patients (594 with proven or probable IFIs), included in 16 studies, were analyzed. The pooled sensitivity of BDG was 76.8% (95% confidence interval [CI], 67.1%-84.3%), and the specificity was 85.3% (95% CI, 79.6%-89.7%). The area under the summary receiver operating characteristic curve was 0.89. Marked statistical heterogeneity was noted. BDG has good diagnostic accuracy for distinguishing proven or probable IFIs from no IFIs. It can be useful in clinical practice, if implemented in the proper setting and interpreted after consideration of its limitations.

Value of β-d-glucan and Candida albicans germ tube antibody for discriminating between Candida colonization and invasive candidiasis in patients with severe abdominal conditions

“…Although the test is not Candida specific, it has been found to be a promising tool to diagnose invasive fungal infections, most of them being IC [6]. The accuracy of BDG for the diagnosis of invasive fungal infections has been discussed in a recent meta-analysis [7]. Also, a test based on the detection of antibodies against the surface of C. albicans germ tubes (CAGTA) has been commercialized [8].…”

Antifungal stewardship considerations for adults and pediatrics

“…61,62 With respect to serum BDG and GM assays, several meta-analyses have noted heterogeneity of results attributed to differences in study design, patient populations (e.g., hematologic vs other), the criteria used to define a positive test, and the definition of IA. [63][64][65][66][67][68] Among highrisk patients with hematologic malignancies and chemotherapy-induced neutropenia or allogeneic HCT, both tests share a similar sensitivity of 60%-80% and specificity of 90% and higher. 69 There may also be a role for combining serum BDG and GM screening in high-risk neutropenic patients.…”

Biomarkers for Invasive Aspergillosis: The Challenges Continue

“…Positive BDG test results were obtained before the results of any other conventional diagnostic method, including cultures, histopathology or radiological criteria, which may make it useful for early evaluation and preemptive initiation of appropriate antifungal treatment. A recent meta-analysis of 16 studies concluded that serum BDG measurement has a good diagnostic accuracy for IFD diagnosed in accordance with the EORTC/MSG criteria, with a pooled sensitivity of 76.8% and a specificity of 85.3% [97]. However, as with the GM studies, there was marked statistical heterogeneity among the studies [25].…”