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The Presence of (1→3)-ß-D-Glucan as Prognostic Marker in Patients After Major Abdominal Surgery.
White, P Lewis; Posso, Raquel; Parr, Christian; Price, Jessica S; Finkelman, Malcolm; Barnes, Rosemary A.
Afiliación
  • White PL; Mycology Reference Laboratory, Microbiology Cardiff, Public Health Wales, Cardiff, United Kingdom.
  • Posso R; Mycology Reference Laboratory, Microbiology Cardiff, Public Health Wales, Cardiff, United Kingdom.
  • Parr C; Infection, Immunity and Biochemistry, School of Medicine, Cardiff University, Cardiff, United Kingdom.
  • Price JS; Mycology Reference Laboratory, Microbiology Cardiff, Public Health Wales, Cardiff, United Kingdom.
  • Finkelman M; Associates of Cape Cod, Inc, East Falmouth, Massachusetts, USA.
  • Barnes RA; Infection, Immunity and Biochemistry, School of Medicine, Cardiff University, Cardiff, United Kingdom.
Clin Infect Dis ; 73(7): e1415-e1422, 2021 10 05.
Article en En | MEDLINE | ID: mdl-32914187
BACKGROUND: While the serological detection of (1→3)-ß-D-glucan (BDG) can indicate invasive fungal disease (IFD), false positivity occurs. Nevertheless, the presence of BDG can still be recognized by the host's innate immune system and persistent BDG antigenemia, in the absence of IFD, can result in deleterious proinflammatory immune responses. METHODS: During the XXX (INTENSE) study into the preemptive use of micafungin to prevent invasive candidiasis (IC) after abdominal surgery, the serum burden of BDG was determined to aid diagnosis of IC. Data from the INTENSE study were analyzed to determine whether BDG was associated with organ failure and patient mortality, while accounting for the influences of IC and antifungal therapy. RESULTS: A BDG concentration >100 pg/mL was associated with a significantly increased Sequential Organ Failure Assessment score (≤100 pg/mL: 2 vs >100 pg/mL: 5; P < .0001) and increased rates of mortality (≤100 pg/mL: 13.7% vs >100 pg/mL: 39.0%; P = .0002). Multiple (≥2) positive results >100 pg/mL or a BDG concentration increasing >100 pg/mL increased mortality (48.1%). The mortality rate in patients with IC and a BDG concentration >100 pg/mL and ≤100 pg/mL was 42.3% and 25.0%, respectively. The mortality rate in patients without IC but a BDG concentration >100 pg/mL was 37.3%. The use of micafungin did not affect the findings. CONCLUSIONS: The presence of persistent or increasing BDG in the patient's circulation is associated with significant morbidity and mortality after abdominal surgery, irrespective of IC. The potential lack of a specific therapeutic focus has consequences when trying to manage these patients, and when designing clinical trials involving patients where host-associated BDG concentrations may be elevated. CLINICAL TRIALS REGISTRATION: NCT01122368.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Beta-Glucanos / Candidiasis Invasiva Tipo de estudio: Diagnostic_studies / Prognostic_studies Límite: Humans Idioma: En Revista: Clin Infect Dis Asunto de la revista: DOENCAS TRANSMISSIVEIS Año: 2021 Tipo del documento: Article País de afiliación: Reino Unido Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Beta-Glucanos / Candidiasis Invasiva Tipo de estudio: Diagnostic_studies / Prognostic_studies Límite: Humans Idioma: En Revista: Clin Infect Dis Asunto de la revista: DOENCAS TRANSMISSIVEIS Año: 2021 Tipo del documento: Article País de afiliación: Reino Unido Pais de publicación: Estados Unidos