Existing tests vs. novel non-invasive assays for detection of invasive aspergillosis in patients with respiratory diseases  

作　　者：Wei Xiao Longyi Du Linli Cai Tiwei Miao Bing Mao Fuqiang Wen Peter Gerard Gibso Deying Gong Yan Zeng Mei Kang Xinmiao Du Junyan Qu Yan Wang Xuemei Liu Ruizhi Feng Juanjuan Fu 

机构地区：[1]Respiratory Group,Department of Integrated Traditional Chinese and Western Medicine,West China Hospital of Sichuan University,Chengdu,Sichuan 610041,China [2]Divison of Pulmonary Diseases,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University,Chengdu,Sichuan 610093,China [3]West China School of Medicine,Sichuan University,Chengdu,Sichuan 610041,China [4]Department of Respiratory and Critical Care Medicine,West China Hospital of Sichuan University,Chengdu,Sichuan 610041,China [5]priority Research Centre for Healthy Lungs,The University of Newcastle,Newcastle,NSW 2305,Australia [6]Priority Research Centre for Asthma and Respiratory Diseases,Hunter Medical Research Institute,Newcastle,NSW 2305,Australia [7]Department of Respiratory and Sleep Medicine,John Hunter Hospital,Newcastle,NSW 2305,Australia [8]Laboratory of Anesthesia and Critical Care Medicine,Translational Neuroscience Center,West China Hospital of Sichuan University,Chengdu,Sichuan 610093,China [9]Department of Pneumology,Pidu District of Traditional Chinese Medicine,The Third Aflated Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu,Sichuan 611730,China [10]Department of Laboratory Medicine,West China Hospital of Sichuan Universty,Chengdu,Sichuan 610041,China [11]Center of Infectious Disease,West China Hospital of Sichuan University,Chengdu,Sichuan 610041,China [12]Research Core Failty,West China Hospital of Sichuan Universit,Chengdu,Sichuan 610093,China.

出　　处：《Chinese Medical Journal》2022年第13期1545-1554,共10页中华医学杂志（英文版）

基　　金：supported by grants from Sichuan Science and Technology Program(No.2019YFS0231);1,3,5 project for disciplines of excellence,West China Hospital,Sichuan University(No.2018-119);the National Natural Science Foundation of China(No.81870014).

摘　　要：Background: Although existing mycological tests (bronchoalveolar lavage [BAL] galactomannan [GM], serum GM, serum (1,3)-β-D-glucan [BDG], and fungal culture) are widely used for diagnosing invasive pulmonary aspergillosis (IPA) in non-hematological patients with respiratory diseases, their clinical utility in this large population is actually unclear. We aimed to resolve this clinical uncertainty by evaluating the diagnostic accuracy and utility of existing tests and explore the efficacy of novel sputum-basedAspergillus assays.Methods: Existing tests were assessed in a prospective and consecutive cohort of patients with respiratory diseases in West China Hospital between 2016 and 2019 while novel sputum assays (especially sputum GM andAspergillus-specific lateral-flow device [LFD]) in a case-controlled subcohort. IPA was defined according to the modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Sensitivity and specificity were computed for each test and receiver operating characteristic (ROC) curve analysis was performed.Results: The entire cohort included 3530 admissions (proven/probable IPA=66, no IPA=3464) and the subcohort included 127 admissions (proven/probable IPA=38, no IPA=89). Sensitivity of BAL GM (≥1.0 optical density index [ODI]: 86% [24/28]) was substantially higher than that of serum GM (≥0.5 ODI: 38% [39/102]) (χ^(2)=19.83,P<0.001), serum BDG (≥70 pg/mL: 33% [31/95]) (χ^(2)=24.65,P<0.001), and fungal culture (33% [84/253]) (χ^(2)=29.38,P<0.001). Specificity varied between BAL GM (≥1.0 ODI: 94% [377/402]), serum GM (≥0.5 ODI: 95% [2130/2248]), BDG (89% [1878/2106]), and culture (98% [4936/5055]). Sputum GM (≥2.0 ODI) had similar sensitivity (84% [32/38]) (Fisher’s exactP=1.000) to and slightly lower specificity (87% [77/89]) (χ^(2)=5.52,P=0.019) than BAL GM (≥1.0 ODI). Area under the ROC curve values were comparable between sputum GM (0.883 [0.812-0.953]) and BAL GM (0.901 [0.824-0.977]) (P=0.734). Sputum LFD had similar specifici

关 键 词：Invasive pulmonary aspergillosis SPUTUM Bronchoalveolar lavage GALACTOMANNAN Lateral-flow device 

分 类 号：R519[医药卫生—内科学]