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Initial serum (1, 3)-β-D-glucan as a predictor of mortality in proven candidemia: findings from a retrospective study in two teaching hospitals in Italy and Brazil.
Clin Microbiol Infect. 2015 Jun 9;
Authors: Giacobbe DR, Esteves P, Bruzzi P, Mikulska M, Furfaro E, Mesini A, Tatarelli P, Grignolo S, Viscoli C, Colombo AL, Del Bono V
Abstract
A retrospective study was conducted to assess the role of initial serum (1, 3)-β-D-glucan (BDG) values in predicting mortality in proven candidemia. The study was conducted in two large teaching hospitals in Italy and Brazil. From January 2009 to June 2014, all patients with proven candidemia who underwent a BDG test within ±96 hours from the first positive blood culture were included in the study. The primary endpoint was 28-day mortality, with the role of initial BDG being assessed by univariate and multivariate analyses. A total of 104 patients met inclusion criteria. Overall, the crude 28-day mortality was 30% (31/104). In the final multivariate model, an initial BDG > 287 pg/ml (OR 4.40, 95% CI 1.56-12.39, p = 0.005), haemodialysis (OR 4.33, 95% CI 1.24-15.17, p = 0.022), and a Pitt score ≥ 2 (OR 4.10, 95% CI 1.24-13.54, p = 0.021) were significant predictors of 28-day mortality. The >287 pg/ml cut-off predicted 28-mortality with 65% sensitivity and 70% specificity. Centre of enrolment (p for interaction = 0.012), haemodialysis (p for interaction = 0.062), and timing of BDG test > ±24 hours from the positive culture (p for interaction = 0.143) appeared to interact with the BDG ability to predict mortality. Although not statistically significant, the last two of these interactions might partially explain why the BDG ability to predict mortality was present only in the Italian cohort.
PMID: 26070961 [PubMed - as supplied by publisher]