Combined Use of Presepsin and (1,3)-beta-D-glucan as Biomarkers for Diagnosing Candida Sepsis and Monitoring the Effectiveness of Treatment in Critically Ill Patients

0556633 - MBÚ 2023 RIV CH eng J - Journal Article
Dobiáš, R. - Kaňová, M. - Petejová, N. - Pisti, S. K. - Boček, R. - Krejčí, E. - Stružková, H. - Cachová, M. - Tomášková, H. - Hamal, P. - Havlíček, Vladimír - Raška, M.
Combined Use of Presepsin and (1,3)-beta-D-glucan as Biomarkers for Diagnosing Candida Sepsis and Monitoring the Effectiveness of Treatment in Critically Ill Patients.
Journal of Fungi. Roč. 8, č. 3 (2022), č. článku 308. E-ISSN 2309-608X
R&D Projects: GA ČR(CZ) GA21-17044S
Institutional support: RVO:61388971
Keywords : intensive-care units * invasive candidiasis * prognostic marker * apache-ii * multicenter * procalcitonin * scd14-st * accuracy * kinetics * disease * sepsis * Candida * bloodstream infections * presepsin * procalcitonin * C-reactive protein * (1,3)-beta-D-glucan
OECD category: Analytical chemistry
Impact factor: 4.7, year: 2022
Method of publishing: Open access
https://www.mdpi.com/2309-608X/8/3/308

New biomarker panel was developed and validated on 165 critically ill adult patients to enable a more accurate invasive candidiasis (IC) diagnosis. Serum levels of the panfungal biomarker (1,3)-beta-D-glucan (BDG) and the inflammatory biomarkers C-reactive protein, presepsin (PSEP), and procalcitonin (PCT) were correlated with culture-confirmed candidemia or bacteremia in 58 and 107 patients, respectively. The diagnostic utility was evaluated in sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). BDG was the best marker for IC, achieving 96.6% sensitivity, 97.2% specificity, 94.9% PPV, and 98.1% NPV at a cut-off of 200 pg/mL (p <= 0.001). PSEP exhibited 100% sensitivity and 100% NPV at a cut-off of 700 pg/mL but had a lower PPV (36.5%) and low specificity (5.6%). Combined use of PSEP and BDG, thus, seems to be the most powerful laboratory approach for diagnosing IC. Furthermore, PSEP was more accurate for 28-day mortality prediction the area under the receiver operating characteristic curve (AUC = 0.74) than PCT (AUC = 0.31, PCT cut-off = 0.5 ng/mL). Finally, serum PSEP levels decreased significantly after only 14 days of echinocandin therapy (p = 0.0012). The probability of IC is almost 100% in critically ill adults with serum BDG and PSEP concentrations > 200 pg/mL and >700 pg/mL, respectively, defining a borderline between non-invasive superficial Candida colonization and IC.
Permanent Link: http://hdl.handle.net/11104/0331533