The value of 1,3-beta-D-glucan assay for diagnosis of invasive fungal disease with automimmune disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LI Xiaoyan ¹ , LI Junlu ¹ , CAO Jie ¹ , WANG Chao ² ,  XING Lihua ¹

1. Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital oF Zhengzhou University, Zhengzhou, Henan 450000, P.R.China;
2. Department of Pathology, The First Affiliated Hospital oF Zhengzhou University, Zhengzhou, Henan 450000, P.R.China;

Corresponding author：

XING Lihua, Email: xinglihualh@126.com

Keywords：

Autoimmune disease; Invasive fungal disease; Diagnosis; 1,3-beta-D-glucan

DOI：

10.7507/1671-6205.201609009

Video：

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ObjectiveTo evaluate the diagnostic value of monitoring 1,3-beta-D-glucan (G test) in patients with autoimmune disease complicated with invasive fungal disease (IFD). MethodsA retrospective study was performed in hospitalized patients in the First Affiliated Hospital of Zhengzhou Universisty who were diagnosed as autoimmune disease with lung infection during the immunosuppressive therapy between January 2014 and January 2016. A total of 372 patients were enrolled in this study. All subjects were classified according to the 2006 diagnostic criteria and treatment of invasive pulmonaary fungal infection, with serum 1,3-β-D-glucan results not included in the diagnosis. There were 18 cases with proven IFD, 35 cases with probable IFD, and 70 ceses with possible IFD. Fifty-three patients with proven IFD or probable IFD were as a case group, and another 249 patients with no evidence for IFD were as a control group. The value of the G test for diagnosis of automimmune disease with IFD was analyzed by ROC curve. ResultsThe serum 1,3-β-D-glucan level was significantly higher in the case group when compared with the control group [median (interquartile range): 135.0 (63.1 to 319.0) pg/ml vs. 75.9 (41.2 to 88.1) pg/ml, P<0.05]. When the cut-off value of serum 1,3-β-D-glucan level was set at 93.8 pg/ml, the sensitivity, specificity, positive predictive value, and negative predictive value for diagnosis of autoimmune disease with IFD were 0.65 (95% CI 0.56 to 0.73), 0.87 (95% CI 0.83 to 0.92), 0.70 (95% CI 0.64 to 0.81), and 0.83 (95% CI 0.79 to 0.88), respectively. ConclusionThe 1,3-beta-D-glucan test is a valuable method for diagnosis of IFD in patients with autoimmune disease.

Citation： LI Xiaoyan, LI Junlu, CAO Jie, WANG Chao, XING Lihua. The value of 1,3-beta-D-glucan assay for diagnosis of invasive fungal disease with automimmune disease. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(3): 237-240. doi: 10.7507/1671-6205.201609009 Copy

1.	Kang KY, Kwok SK, Ju JH, et al. The causes of death in Korean patients with systemic lupus erythematosus over 11 years. Lupus, 2011, 20(9): 989-997.
2.	Mok CC, Kwok CL, Ho LY, et al. Life expectancy, standardized mortality ratios, and causes of death in six rheumatic diseases in Hong Kong, China. Arthritis Rheumatol, 2011, 63(5): 1182-1189.
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8.	邹婕, 张振纲, 李慎秋. 皮肌炎合并感染 106 例临床分析. 临床内科杂志, 2011, 28(12): 823-825.
9.	费允云, 侍效春, 甘凤英, 等. 系统性红斑狼疮死亡患者感染部位和病原菌分析. 中华风湿病学杂志, 2012, 16(5): 309-312.
10.	Gladman DD, Hussain F, Iban D, et al. The nature and outcome of infection in systemic lupus erythematosus. Lupus, 2002, 11(4): 234-239.
11.	Yunt ZX, Solomon JJ. Lung disease in rheumatoid arthritis. Rheum Dis Clin North Am, 2015, 41(2): 225-236.
12.	刘又宁, 佘丹阳, 孙铁英, 等. 中国 1998 年至 2007 年临床确诊的肺真菌病患者的多中心回顾性调查. 中华结核和呼吸杂志, 2011, 34(2): 86-90.
13.	屈晶晶, 胡成平, 顾其华, 等. 侵袭性肺真菌感染的临床与病原学分析. 中国呼吸与危重症监护杂志, 2012, 11(6): 545-549.
14.	Lin SJ, Schranz J, Teutsch SM. Aspergillosis case-fatality rate: systematic review of the literature. Clin Infect Dis, 2001, 32(3): 358-366.
15.	张静, 何礼贤. 侵袭性肺真菌病诊治指南解读. 中国药物应用与监测, 2011, 8(5): 261-265.
16.	Shelton BK. Opportunistic fungal infections in the critically ill. Crit Care Nurs Clin North Am, 2000, 12(3): 323-340.
17.	中华医学会呼吸病学分会. 社区获得性肺炎诊断和治疗指南. 中华结核和呼吸杂志, 2006, 29(10): 651-655.
18.	中华内科杂志编辑委员会. 侵袭性肺部真菌感染的诊断标准与治疗原则(草案). 中国实用内科杂志, 2006, 26(8): 697-700.
19.	Azoulay E, Guigue N, Darmon M, et al. (1,3)-β-D-glucan assay for diagnosing invasive fungal infections in critically ill patients with hematological malignancies. Oncotarget, 2016, 7(16): 21484-21495.
20.	Reischies FMJ, Prattes J, Woelfler A, et al. Diagnostic performance of 1,3-beta-D-glucan serum screening in patients receiving hematopoietic stem cell transplantation. Transpl Infect Dis, 2016, 18(3): 466-470.
21.	Hou TY, Wang SH, Liang SX, et al. The screening performance of serum 1,3-Beta-D-glucan in patients with invasive fungal diseases: a meta-analysis of prospective cohort studies. PloS One, 2015, 10(7): e0131602.

1. Kang KY, Kwok SK, Ju JH, et al. The causes of death in Korean patients with systemic lupus erythematosus over 11 years. Lupus, 2011, 20(9): 989-997.
2. Mok CC, Kwok CL, Ho LY, et al. Life expectancy, standardized mortality ratios, and causes of death in six rheumatic diseases in Hong Kong, China. Arthritis Rheumatol, 2011, 63(5): 1182-1189.
3. 费允云, 甘凤英, 侯勇, 等. 近 25 年系统性红斑狼疮的死因构成回顾性研究. 中华风湿病学杂志, 2012, 16(9): 596-600.
4. Doran M, Crowson C, Pond G, et al. Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheumatol, 2002, 46(9): 2287-2293.
5. 高莉, 贾园, 刘萍, 等. 类风湿关节炎患者 91 例死亡原因及预后因素分析. 中华风湿病学杂志, 2013, 17(8): 542-545.
6. Marie I, Ménard JF, Hachulla E, et al. Infectious complications in polymyositis and dermatomyositis: a series of 279 patients. Semin Arthritis Rheum, 2011, 41(1): 48-60.
7. Schiopu E, Phillips K, Macdonald P M, et al. Predictors of survival in a cohort of patients with polymyositis and dermatomyositis: effect of corticosteroids, methotrexate and azathioprine. Arthritis Res Ther, 2012, 14(1): 125-130.
8. 邹婕, 张振纲, 李慎秋. 皮肌炎合并感染 106 例临床分析. 临床内科杂志, 2011, 28(12): 823-825.
9. 费允云, 侍效春, 甘凤英, 等. 系统性红斑狼疮死亡患者感染部位和病原菌分析. 中华风湿病学杂志, 2012, 16(5): 309-312.
10. Gladman DD, Hussain F, Iban D, et al. The nature and outcome of infection in systemic lupus erythematosus. Lupus, 2002, 11(4): 234-239.
11. Yunt ZX, Solomon JJ. Lung disease in rheumatoid arthritis. Rheum Dis Clin North Am, 2015, 41(2): 225-236.
12. 刘又宁, 佘丹阳, 孙铁英, 等. 中国 1998 年至 2007 年临床确诊的肺真菌病患者的多中心回顾性调查. 中华结核和呼吸杂志, 2011, 34(2): 86-90.
13. 屈晶晶, 胡成平, 顾其华, 等. 侵袭性肺真菌感染的临床与病原学分析. 中国呼吸与危重症监护杂志, 2012, 11(6): 545-549.
14. Lin SJ, Schranz J, Teutsch SM. Aspergillosis case-fatality rate: systematic review of the literature. Clin Infect Dis, 2001, 32(3): 358-366.
15. 张静, 何礼贤. 侵袭性肺真菌病诊治指南解读. 中国药物应用与监测, 2011, 8(5): 261-265.
16. Shelton BK. Opportunistic fungal infections in the critically ill. Crit Care Nurs Clin North Am, 2000, 12(3): 323-340.
17. 中华医学会呼吸病学分会. 社区获得性肺炎诊断和治疗指南. 中华结核和呼吸杂志, 2006, 29(10): 651-655.
18. 中华内科杂志编辑委员会. 侵袭性肺部真菌感染的诊断标准与治疗原则(草案). 中国实用内科杂志, 2006, 26(8): 697-700.
19. Azoulay E, Guigue N, Darmon M, et al. (1,3)-β-D-glucan assay for diagnosing invasive fungal infections in critically ill patients with hematological malignancies. Oncotarget, 2016, 7(16): 21484-21495.
20. Reischies FMJ, Prattes J, Woelfler A, et al. Diagnostic performance of 1,3-beta-D-glucan serum screening in patients receiving hematopoietic stem cell transplantation. Transpl Infect Dis, 2016, 18(3): 466-470.
21. Hou TY, Wang SH, Liang SX, et al. The screening performance of serum 1,3-Beta-D-glucan in patients with invasive fungal diseases: a meta-analysis of prospective cohort studies. PloS One, 2015, 10(7): e0131602.

Chinese Journal of Respiratory and Critical Care Medicine

The value of 1,3-beta-D-glucan assay for diagnosis of invasive fungal disease with automimmune disease

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