Limited Positive Predictive Value of β-d-Glucan in Hematologic Patients Receiving Antimold Prophylaxis. (12th February 2020)

• Record Type: Journal Article
• Authors: Chang, Euijin; Kim, Taek Soo; Kang, Chang Kyung; Jun, Kang Il; Shin, Dongyeop; Koh, Youngil; Hong, Junshik; Choe, Pyoeng Gyun; Park, Wan Beom; Kim, Nam-Joong; Yoon, Sung-Soo; Kim, Inho; Oh, Myoung-don
• Is Part Of: Open forum infectious diseases. Volume 7:Number 3(2020)
• Publication Date: 2020-02-12
• Subjects: antimold prophylaxis -- β-d-glucan -- fungal diagnostics -- hematologic diseases; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofaa048
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Diagnostic value of β-d -glucan (BDG) in populations with low prevalence of invasive fungal infection (IFI), such as hematologic patients receiving antimold prophylaxis, should be re-evaluated. Methods: We retrospectively reviewed episodes with BDG results in hematologic patients receiving antimold prophylaxis from January 2017 to August 2019 in a tertiary hospital. The episodes were classified as true positive ([TP] positive BDG with IFI), true negative ([TN] negative BDG without IFI), false positive ([FP] positive BDG without IFI), false negative ([FN] negative BDG with IFI), and nonevaluable. Results: A total of 203 episodes were analyzed: 101 episodes (49.8%) were from stem cell transplants, 89 (43.8%) were from induction chemotherapy, and 13 (6.4%) were from graft-versus-host disease treatment. There were 62 nonevaluable episodes. Among 141 evaluable ones, there were 8 (5.7%) episodes of probable/proven IFI. True positive, TN, FP, and FN cases were 4 (2.8%), 112 (79.4%), 21 (14.9%), and 4 (2.8%) episodes, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value were 50.0%, 84.2%, 16.1%, and 96.5%, respectively. Positive predictive value was 26.7% and 0.0% in diagnostic and surveillance episodes, respectively. Conclusions: β-d -glucan test should be used to exclude IFI rather than for diagnosis in these patients. Abstract : The positive predictive value of β-d -glucan was low in hematologic patients who are taking prophylactic posaconazole or micafungin. β-d -glucan (BDG) test is not helpful in diagnosing IFIs in those patients.