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

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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.	鄒婕, 張振綱, 李慎秋. 皮肌炎合并感染 106 例臨床分析. 臨床內科雜志, 2011, 28(12): 823-825.
9.	費允云, 侍效春, 甘鳳英, 等. 系統性紅斑狼瘡死亡患者感染部位和病原菌分析. 中華風濕病學雜志, 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.	劉又寧, 佘丹陽, 孫鐵英, 等. 中國 1998 年至 2007 年臨床確診的肺真菌病患者的多中心回顧性調查. 中華結核和呼吸雜志, 2011, 34(2): 86-90.
13.	屈晶晶, 胡成平, 顧其華, 等. 侵襲性肺真菌感染的臨床與病原學分析. 中國呼吸與危重癥監護雜志, 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.	張靜, 何禮賢. 侵襲性肺真菌病診治指南解讀. 中國藥物應用與監測, 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.	中華醫學會呼吸病學分會. 社區獲得性肺炎診斷和治療指南. 中華結核和呼吸雜志, 2006, 29(10): 651-655.
18.	中華內科雜志編輯委員會. 侵襲性肺部真菌感染的診斷標準與治療原則(草案). 中國實用內科雜志, 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. 費允云, 甘鳳英, 侯勇, 等. 近 25 年系統性紅斑狼瘡的死因構成回顧性研究. 中華風濕病學雜志, 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, 賈園, 劉萍, 等. 類風濕關節炎患者 91 例死亡原因及預后因素分析. 中華風濕病學雜志, 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. 鄒婕, 張振綱, 李慎秋. 皮肌炎合并感染 106 例臨床分析. 臨床內科雜志, 2011, 28(12): 823-825.
9. 費允云, 侍效春, 甘鳳英, 等. 系統性紅斑狼瘡死亡患者感染部位和病原菌分析. 中華風濕病學雜志, 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. 劉又寧, 佘丹陽, 孫鐵英, 等. 中國 1998 年至 2007 年臨床確診的肺真菌病患者的多中心回顧性調查. 中華結核和呼吸雜志, 2011, 34(2): 86-90.
13. 屈晶晶, 胡成平, 顧其華, 等. 侵襲性肺真菌感染的臨床與病原學分析. 中國呼吸與危重癥監護雜志, 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. 張靜, 何禮賢. 侵襲性肺真菌病診治指南解讀. 中國藥物應用與監測, 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. 中華醫學會呼吸病學分會. 社區獲得性肺炎診斷和治療指南. 中華結核和呼吸雜志, 2006, 29(10): 651-655.
18. 中華內科雜志編輯委員會. 侵襲性肺部真菌感染的診斷標準與治療原則(草案). 中國實用內科雜志, 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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