• Crit Care · Jul 2024

    Observational Study

    Prognostic value of serial (1,3)-β-D-glucan measurements in ICU patients with invasive candidiasis.

    • Simone Carelli, Brunella Posteraro, Riccardo Torelli, Elena De Carolis, Maria Sole Vallecoccia, Rikardo Xhemalaj, Salvatore Lucio Cutuli, Eloisa Sofia Tanzarella, Antonio Maria Dell'Anna, Gianmarco Lombardi, Fabiola Cammarota, Alessandro Caroli, Domenico Luca Grieco, Maurizio Sanguinetti, Massimo Antonelli, and Gennaro De Pascale.
    • Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy. simone.carelli@policlinicogemelli.it.
    • Crit Care. 2024 Jul 12; 28 (1): 236236.

    BackgroundTo determine whether a decrease in serum (1,3)-β-D-glucan (BDG) was associated with reduced mortality and to investigate the performance of BDG downslope in predicting clinical outcome in invasive candidiasis.MethodsObservational cohort study in ICU patients over a ten-year period (2012-2022) in Italy. Proven invasive candidiasis with at least 2 BDG determinations were considered.ResultsIn the study population of 103 patients (age 47 [35-62] years, SAPS II score 67 [52-77]) 68 bloodstream and 35 intrabdominal infections were recorded. Serial measurements showed that in 54 patients BDG decreased over time (BDG downslope group) while in 49 did not (N-BDG downslope group). Candida albicans was the pathogen most frequently isolated (61%) followed by C. parapsilosis (17%) and C. glabrata (12%), in absence of any inter-group difference. Invasive candidiasis related mortality was lower in BDG downslope than in N-BDG downslope group (17% vs 53%, p < 0.01). The multivariate Cox regression analysis showed the association of septic shock at infection occurrence and chronic liver disease with invasive candidiasis mortality (HR [95% CI] 3.24 [1.25-8.44] p = 0.02 and 7.27 [2.33-22.66] p < 0.01, respectively) while a BDG downslope was the only predictor of survival (HR [95% CI] 0.19 [0.09-0.43] p < 0.01). The area under the receiver operator characteristic curve for the performance of BDG downslope as predictor of good clinical outcome was 0.74 (p = 0.02) and our model showed that a BDG downslope > 70% predicted survival with both specificity and positive predictive value of 100%.ConclusionsA decrease in serum BDG was associated with reduced mortality and a steep downslope predicted survival with high specificity in invasive candidiasis.© 2024. The Author(s).

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