CC:(1,3)-β-D-葡聚糖检测在ICU病房感染性念珠菌病中的价值

Abstract

Background To determine whether a decrease in serum (1,3)-β-d-glucan (BDG) was associated with reduced mortality and to investigate the performance of BDG downslope in predicting clinical outcome in invasive candidiasis.以确定血清(1,3) D -葡聚糖(BDG)与降低死亡率有关,并研究了BDG下降在预测侵袭性念珠菌病临床结果方面的性能。

Methods Observational cohort study in ICU patients over a ten-year period (2012–2022) in Italy. Proven invasive candidiasis with at least 2 BDG determinations were considered.10年(2012-2022)意大利ICU患者观察性队列研究。证实侵袭性念珠菌病至少有2个BDG检测被考虑。

Results In the study population of 103 patients (age 47 [35–62] years, SAPS II score 67 [52–77]) 68 bloodstream and 35 intrabdominal infections were recorded. Serial measurements showed that in 54 patients BDG decreased over time (BDG downslope group) while in 49 did not (N-BDG downslope group). Candida albicans was the pathogen most frequently isolated (61%) followed by C. parapsilosis (17%) and C. glabrata (12%), in absence of any inter-group difference. Invasive candidiasis related mortality was lower in BDG downslope than in N-BDG downslope group (17% vs 53%, p < 0.01). The multivariate Cox regression analysis showed the association of septic shock at infection occurrence and chronic liver disease with invasive candidiasis mortality (HR [95% CI] 3.24 [1.25–8.44] p = 0.02 and 7.27 [2.33–22.66] p < 0.01, respectively) while a BDG downslope was the only predictor of survival (HR [95% CI] 0.19 [0.09–0.43] p < 0.01). The area under the receiver operator characteristic curve for the performance of BDG downslope as predictor of good clinical outcome was 0.74 (p = 0.02) and our model showed that a BDG downslope > 70% predicted survival with both specificity and positive predictive value of 100%. 在103例患者(年龄47[35 – 62]岁，SAPS II评分67[52-77])中，记录68例血流感染和35例腹腔内感染。连续测量显示，54例患者BDG随时间下降(BDG下降组)，49例患者没有下降(N-BDG下降组)。白色念珠菌是最常见的病原菌(61%)，其次是假丝酵母菌(17%)和光滑假丝酵母菌(12%)，各组间无差异。BDG下降组侵袭性念珠菌病相关死亡率低于N-BDG下降组(17% vs 53%， p < 0.01)。多因素Cox回归分析显示，感染性休克和慢性肝病与侵袭性念珠菌病死亡率相关(HR [95% CI] 3.24 [1.25-8.44] p = 0.02和7.27 [2.33-22.66]p < 0.01)，而BDG下降是唯一的生存预测因子(HR [95% CI] 0.19 [0.09-0.43] p < 0.01)。BDG下降作为良好临床预后预测指标的接受者操作者特征曲线下面积为0.74 (p = 0.02)，我们的模型显示，BDG下降> 70%预测生存，特异性和阳性预测值均为100%。

Conclusions A decrease in serum BDG was associated with reduced mortality and a steep downslope predicted survival with high specificity in invasive candidiasis. 血清BDG的下降与死亡率的降低有关,并与侵袭性念珠菌病的高特异性预测生存率有关。