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| The value of G test and GM test of bronchoalveolar lavage fluid in the early diagnosis of invasive pulmonary fungal infection |
| Fang Yu, Zhang Pin-jie, Yang Xiang, Cao Li-jun, Sun Yun, Zhao Hui |
| Department of Intensive Care Unit, the Second Hospital of Anhui Medical University, Hefei 230601, China |
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Abstract Objective To study the value of bronchoalalveolar lavage fluid (BALF) G test and GM test in the early diagnosis of invasive pulmonary fungal infection (IPFI). Methods A total of 95 patients with IPFI risk factors in the intensive care department of the Second Hospital of Anhui Medical University from January 2017 to March 2018 were prospectively collected. According to expert consensus on diagnosis and treatment of pulmonary mycosis, all patients were divided into IPFI group (43 cases) and non-IPFI group (52 cases). Patients were divided into invasive pulmonary aspergillosis (IPA) and non-IPA group according to whether they had aspergillosis. Serum, BALF G and GM tests were performed in all patients. The differences in BALF G and GM test results between the groups were analyzed and compared with the results of serum G and GM test. The diagnostic value of the above indicators was analyzed by drawing the ROC curve. Results ①BALF G test results of the IPFI group and the non-IPFI group were (294.07±137.78) ng/L and (94.74±46.21) ng/L, respectively, with statistically significant differences (P=0.000). The results of serum G test in IPFI group and non-IPFI group were (25.26±12.17) ng/L and (15.02±6.05) ng/L, respectively, with statistically significant difference (P=0.036). BALF GM test results of IPA group and non-IPA group were (2.68±1.98) and (0.53±0.40), respectively, and the difference was statistically significant (P=0.001). The results of serum GM test in IPA group and non-IPA group were (0.63±0.21) and (0.25±0.17), respectively, and the difference was statistically significant (P=0.030). ②The area under the ROC curve of BALF G test for early diagnosis of IPFI was 0.900 (P<0.001), the 95% confidence interval was 0.841-0.960, the optimal diagnostic threshold was 157 ng/L, and the Youden index, sensitivity and specificity were 0.64, 81.2% and 83.1%, respectively. The area under the curve of serum G test for early diagnosis IPFI was 0.556 (P=0.35), the optimal diagnostic threshold was 22 ng/L, and its Youden index, sensitivity and specificity were 0.11, 37.2% and 73.1%, respectively. ③The area under the curve of BALF GM test for early diagnosis of IPA was 0.99 (P<0.001), the 95% confidence interval was 0.936-1.000, and the optimal threshold was 1.08. The Youden index, sensitivity and specificity were 0.918, 99.0% and 92.8%, respectively. The area under the curve of serum GM test for early diagnosis of IPA was 0.732 (P=0.025), and the 95% confidence interval was 0.590-0.875. When 0.5 was the diagnostic threshold, the Youden index, sensitivity and specificity were 0.443, 88.9% and 55.7%, respectively. Conclusion The sensitivity and specificity of BLAF G test and GM test for the diagnosis of IPFI and IPA are significantly better than serum, which is conducive to the early diagnosis and treatment of IPFI and IPA. The threshold of BALF G test for IPFI prediction is 157 ng/L, and the threshold of BALF GMtest for IPA prediction is 1.08.
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Corresponding Authors:
Sun Yun, E-mail: sunyun15@163.com
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