Diagnostic Value Of Glucan Test And Galactomannan Test In The Non-neutropenic Patients At Risk For Invasive Pulmonary Fungal Infections

ObjectiveTo evaluate the diagnostic performance of 1,3-beta-D-glucan and galactomannan(GM)detectionin in serum and BALF for invasive pulmonary fungal infections(IPFI)in non-neutropenic patients.MethodsThe clinical data of 149 patients who were suspected invasive pulmonary fungal infections during the hospitalization period from January 2011 to March 2017 in Shandong Provincial Hospital were collected and retrospectively analyzed.Possible cases(n=52),probable cases(n=42)and proven cases(n=12)were enrolled in the IPFI group,and 43 cases for diagnosis of non-IPFI into the non-IPFI group.The levels of 1,3-beta-D-glucan and galactomannan in the serum were compared,and to analyze the sensitivity,specificity and cut off value of serum G/GM test.Subgroup study:In the study group,19 patients who were measured the levels of galactomannan in serum and bronchoalveolar lavage fluid during the hospitalization period were divided into the observation group(n=12)and the control group(n=7).The levels of galactomannan in serum and bronchoalveolar lavage fluid were compared,and to analyze the sensitivity,specificity,positive predictive value and negative predictive value at the different cut-off values.Results.1.The levels of 1,3-beta-D-glucan in the serum in IPFI group were higher than those in non-IPFI group(P<0.019).The sensitivity,specificity and cut-off value were 39.6%,89.4%,152.8 pg/ml.2.The levels of galactomannan in the serum in IPFI group were significantly higher than those in non-IPFI group(P=0.000).The sensitivity,specificity and cut-off value were 52.9%,77.5%,0.4615 ug/L.3.Subgroup results:The galactomannan concentrations in BALF between two groups had a significant difference(P=0.000).The galactomannan concentration in serum compared with that in BALF both from observation group also had a significant difference(P=0.001).Whatever the cut-off value was 0.5 or 1.0,the sensitivity,specificity,positive predictive value and negative predictive value of the BALF GM test were higher than those of the serum GM test.ConclusionsThe sensitivity of serum G/GM test in diagnosing invasive pulmonary fungal diseases is acceptable and the specificity is high,and it is still valuable for early diagnosis.The value of BALF GM test for IPFI diagnosis,Were higher than the serum GM test,but because of its invasive lung operation,clinical application should pay attention to assess the patient's situation and to avoid the risk of fungal colonization.