Value of consecutive galactomannan determinations for the diagnosis and prognosis of invasive pulmonary aspergillosis in critically ill chronic obstructive pulmonary disease
贺航咏1 丁琳1 栗方1 詹庆元1
Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University
Background: Critically ill chronic obstructive pulmonary disease (COPD) patients who require intensive care unit (ICU) admission are at particular risk of invasive pulmonary aspergillosis (IPA).
Objectives: To investigate the value of consecutive galactomannan (GM) determinations for the diagnosis and prognosis of IPA in critically ill COPD patients.
Patients/Methods: We studied 90 critically ill COPD patients admitted to our respiratory ICU between February 2007 and November 2009. Two consecutive serum GM detections were done at the first and fourth day of their ICU admission.
Results: The patients were classified as proven (n=1), probable IPA (n=18), colonization (n=1) or non-IPA (n=71). The sensitivity, specificity, and positive and negative predictive values for the first single GM detection, at least one positive in two consecutive detections and both positive of two consecutive GM detections were 57.9%/70.6%/47.1%, 87.3%/80.8%/94.2%, 55.0%/54.5%/72.7%, and 88.6%/89.4%/84.5%, respectively, and the mortality of each diagnostic strategy group were 63.2% (12/19), 54.6% (12/22) and 81.8% (9/11), respectively.
Conclusion: At least one positive of two consecutive serum GM detections could prove to be useful in establishing the diagnosis of IPA in critically ill COPD patients in the ICU. And both positive of the two consecutive serum GM detections may be associated with high mortality.
