Galactomannan In Bronchoalveolar Lavage Fluid For Diagnosis Of Invasive Pulmonary Aspergillosis With Nonneutropenic Patients

Objective:To evaluate the utility of galactomannan(GM)in bronchoalveolar lavage fluid(BALF)for the diagnosis of invasive pulmonary aspergillosis(IPA)in non-neutropenic patients,we conducted this retrospective study.Materials and Methods:All non-neutropenic patients coming from Affiliated Hospital of Ningbo University,who were admitted to Respiratory Medicine Department from April 2014 to February 2017,were reviewed.Based on the inclusion and exclusion criteria,a total of 183 patients were included in the final analysis.Bronchoscopies and the detection of GM in BALF were all performed on them.Each of the included IPA patients was classified based on the criteria of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group(EORTC/MSG)revised in 2008.To acquire the optimal cutoff index,the receiver operating characteristic(ROC)curve was used.Moreover,between in proven or probable IPA group and non-IPA remaining group,we investigate the difference of clinical symptoms and radiological findings.Besides,to analyze the influences of different risk factors on BALF GM detection,non-IPA remaining patients were divided into two groups:patients with positive BALF GM results(case patients)and patients with negative BALF GM results(control patients).Statistical methods:All dates were analyzed by statistics software SPSS 16.0.BALF GM assay should be calculated sensitivity,specificity,positive predictive index(PPV)and negative predictive index(NPV).Quantitative variables were compared using t-tests.For qualitative date,Pearson's?~2 or Fisher's exact tests were used.Logistic regression analysis was performed to identify risk factors for false-positive BALF GM results.A P value of<0.05 was considered statistically significant.Results:Ten cases of IPA were diagnosed.ROC data demonstrated that for diagnosing IPA,an optimal cutoff value for GM in BALF of 0.76 yielded a sensitivity of 100.0%and a specificity of 76.2%.Area under the curve=0.88(95%CI 0.82-0.94).Symptoms and radiological findings were no significant difference between in proven or probable IPA group and non-IPA remaining group.In our case-control analysis,although nine patients with false-positive results were treatment with Piperacillin/tazobactam,there was no significant difference between case and control group.Conclusions:BALF GM detection is a valuable adjunctive diagnostic tool in non-neutropenic patients.Our retrospective study suggests that the optimal value of GM detection in BALF is 0.76.Besides,the symptoms and radiological findings are non-specific.