The Application Of Serum(1,3)-β-D Glucan In The Diagnosis Of Neonatal Invasive Fungal Infection

Objective: Serum(1,3)-β-D glucan(BDG)performs well in adult tumor-related or ICU patients in diagnosis of invasive fungal infection(IFI),but there is few studies focused on this biomarker in the diagnosis of pediatric and neonatal patients.Here,we want to explore the use of BDG alone or combined with other inflammatory markers such as C-response protein(CRP),procalcitonin(PCT)or platelet(PLT)in diagnosis of neonatal IFI.Methods: This is a retrospective cohort study,we retrospectively collected the clinical and laboratory data of neonates suspected with invasive infection,and separated the patients according to the result of microbiology examination,and then compared the results of BDG,CRP,PCT and WBC and PLT count between groups.We then evaluated the use of these indicators in diagnosis the neonatal IFI via drawing the ROC,and then we accessed the possibility of combining use of these indicators in IFI.At last,we accessed the use of BDG in monitoring the antifungal treatment effects in neonatal patients.Results: C.albicans and C.parapsilosis are the dominant isolated fungal pathogen of neonatal IFI,and candidaemia is the most common IFI in neonates.Though,C.albicans is the most common isolated pathogen,there is a decrease of isolation rate of this pathogen in recent years;In contrast,the isolation rate of non-C.albicans is increased,represented by C.parapsilosis.There is no statistical difference of WBC count between groups,and leukopenia is more common seen than leukocytosis.More than 70% of IFI neonates encounter thrombopenia.Compared with control group,the serum BDG level in IFI group is significant increased.The AUC of the ROC of BDG is 0.82,with a sensitivity of 70% and a specificity of 80% at cut-off 20mg/ml.Combined with inflammatory indicators such as CRP,PCT and PLT further increase the AUC of ROC to 0.923,0.854 and 0.854,respectively.Serum BDG level is decreased along with the antifungal treatment.Conclusion: Serum BDG performs well in diagnosis of neonatal IFI,combined with CRP,PCT and PLT count could further increase the diagnostic value;combined of BDG and CRP have most prominent diagnostic value.Serum BDG could be used in monitoring the treatment effect of antifungal therapy.