Aspergillus Galactomannan Titer as a Diagnostic Marker of Invasive Pulmonary Aspergillosis in Lung Transplant Recipients: A Single-Center Retrospective Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Inclusion and Exclusion Criteria
2.2. Proven IPA
2.3. Probable IPA
2.4. Pneumonia Unrelated to IPA
2.5. Antifungal Prophylaxis and Treatment
2.6. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Demographic Variables | Proven IPA | Probable IPA | Non-IPA Pneumonia | Total |
---|---|---|---|---|
Number of patients, n | 26 | 40 | 75 | 141 |
Total cases, n | 39 | 61 | 164 | 264 |
Age at transplantation, years median (IQR) | 55 (18–73) | 54 (17–71) | 55 (16–75) | 55 (16–75) |
Male, n (%) | 17 (63.4) | 25 (62.5) | 47 (62.7) | 89 (63.1) |
BMI (kg/m2), median (IQR) | 19.6 (11.6–25.2) | 21.0 (13.4–32.9) | 20.6 (12.9–29.5) | 20.6 (11.6–32.9) |
Underlying cause of transplantation, n (%) | ||||
IPF | 14 (53.8) | 18 (45.0) | 38 (50.2) | 70 (49.6) |
Other lung disease * | 12 (46.2) | 22 (55.0) | 37 (49.8) | 71 (50.4) |
Underlying disease, n (%) | ||||
Hypertension | 6 (23.1) | 9 (22.5) | 17 (22.7) | 32 (22.7) |
Diabetes mellitus | 11 (42.3) | 10 (25.0) | 12 (16.0) | 33 (23.4) |
Chronic kidney disease | 0 (0.0) | 4 (10.0) | 4 (5.3) | 8 (5.7) |
Liver cirrhosis | 0 (0.0) | 0 (0.0) | 1 (1.3) | 1 (0.7) |
CVD | 3 (11.5) | 4 (10.0) | 8 (10.6) | 15 (10.6) |
Level, mean ± SD | ||||
Serum Aspergillus galactomannan antigen (index) | 1.12 ± 1.81 | 1.03 ± 171 | 0.13 ± 0.48 | 0.49 ± 1.22 |
BALF Aspergillus galactomannan antigen (index) | 4.58 ± 3.31 | 2.24 ± 2.50 | 0.2 ± 0.55 | 1.46 ± 1.81 |
Serum beta-D Glucan titer (pg/mL) | 204 ± 255 | 267 ± 320 | 107 ± 211 | 191 ± 275 |
Combined fungal infection, n (%) | ||||
Candida spp. | 10 (38.5) | 24 (60.0) | 40 (53.3) | 74 (52.5) |
Mucormycosis | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
Saccharomyces spp. | 1 (3.9) | 4 (10.0) | 1 (1.3) | 6 (4.3) |
Other fungal infection | 1 (3.9) | 2 (5.0) | 2 (2.6) | 5 (3.5) |
Type of lung transplant, n (%) | ||||
Double | 24 (92.3) | 40 (100) | 74 (98.7) | 138 (97.9) |
Single | 2 (7.7) | 0 (0.0) | 1 (3.0) | 3 (2.1) |
Univariate | Multivariate | |||
---|---|---|---|---|
Variables | OR (95% CI) | p-Value | OR (95% CI) | p-Value |
Female sex | 1.04 (0.63–1.72) | 0.877 | 2.14 (0.91–5.16) | 0.084 |
Age (<30) | ||||
31–40 | 0.26 (0.05–1.17) | 0.090 | 0.15 (0.01–2.08) | 0.169 |
41–50 | 0.38 (0.07–1.59) | 0.199 | 0.05 (0.00–0.82) | 0.042 |
51–60 | 0.22 (0.04–0.89) | 0.040 | 0.06 (0.00–0.84) | 0.042 |
61–70 | 0.37 (0.07–1.50) | 0.177 | 0.06 (0.00–0.86) | 0.044 |
>70 | 0.30 (0.04–2.08) | 0.236 | 0.18 (0.00–5.76) | 0.348 |
BMI (<15) | ||||
15 ≤ BMI < 20 | 0.42 (0.16–1.08) | 0.071 | ||
20 ≤ BMI < 25 | 0.73 (0.28–1.86) | 0.505 | ||
25 ≤ BMI < 30 | 0.38 (0.12–1.16) | 0.092 | ||
Underlying cause of transplantation | ||||
ILD except IPF and RA-ILD | 0.37 (0.15–0.80) | 0.017 | ||
IPF | 1.10 (0.67–1.80) | 0.713 | ||
COPD | 1.04 (0.37–2.72) | 0.944 | ||
RA-ILD | 2.02 (0.94–4.39) | 0.072 | ||
BO | 1.05 (0.42–2.49) | 0.916 | ||
Others | 1.09 (0.46–2.51) | 0.838 | ||
Lung transplantation type, double | 0.92 (0.15–7.09) | 0.930 | ||
Underlying disease | ||||
Hypertension | 0.65 (0.36–1.15) | 0.144 | ||
Diabetes mellitus | 3.45 (1.98–6.07) | <0.001 | 3.73 (1.45–9.98) | 0.007 |
CVD | 3.52 (1.76–7.33) | 0.001 | ||
Combined fungal infection | ||||
Candida spp. | 1.43 (0.87–2.37) | 0.164 | ||
Other fungal infection | 7.24 (2.23–32.37) | 0.003 | ||
Serum AGT | 4.04 (2.34–7.80) | <0.001 | 3.11 (1.54–8.26) | 0.011 |
BALF AGT | 7.07 (3.64–15.22) | <0.001 | 4.80 (2.58–10.52) | <0.001 |
Serum beta-D glucan | 1.00 (1.00–1.01) | 0.051 |
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Kim, E.-Y.; Yong, S.-H.; Sung, M.-D.; Woo, A.-L.; Park, Y.-M.; Kim, H.-E.; Jung, S.-J.; Kim, S.-Y.; Lee, J.-G.; Kim, Y.-S.; et al. Aspergillus Galactomannan Titer as a Diagnostic Marker of Invasive Pulmonary Aspergillosis in Lung Transplant Recipients: A Single-Center Retrospective Cohort Study. J. Fungi 2023, 9, 527. https://doi.org/10.3390/jof9050527
Kim E-Y, Yong S-H, Sung M-D, Woo A-L, Park Y-M, Kim H-E, Jung S-J, Kim S-Y, Lee J-G, Kim Y-S, et al. Aspergillus Galactomannan Titer as a Diagnostic Marker of Invasive Pulmonary Aspergillosis in Lung Transplant Recipients: A Single-Center Retrospective Cohort Study. Journal of Fungi. 2023; 9(5):527. https://doi.org/10.3390/jof9050527
Chicago/Turabian StyleKim, Eun-Young, Seung-Hyun Yong, Min-Dong Sung, A-La Woo, Young-Mok Park, Ha-Eun Kim, Su-Jin Jung, Song-Yee Kim, Jin-Gu Lee, Young-Sam Kim, and et al. 2023. "Aspergillus Galactomannan Titer as a Diagnostic Marker of Invasive Pulmonary Aspergillosis in Lung Transplant Recipients: A Single-Center Retrospective Cohort Study" Journal of Fungi 9, no. 5: 527. https://doi.org/10.3390/jof9050527