Prognostic value of serum galactomannan index in critically ill patients with chronic obstructive pulmonary disease at risk of invasive pulmonary aspergillosis

• Published in: Chinese medical journal Vol. 127; no. 1; pp. 23 - 28
• Main Authors: He, Hangyong, Li, Qian, Chang, Shuo, Ding, Lin, Sun, Bing, Li, Fang, Zhan, Qingyuan
• Format: Journal Article
• Language: English
• Published: China Department of Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China 2014; Department of Respiratory and Critical Care Medicine , Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University,Beijing 100020, China%Department of Respiratory Medicine, Fuxing Hospital, Capital Medical University, Beijing 100045, China%Cardiac Center, Fuwai Hospital, National Center for Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037, China%Department of Infectious Diseases and Clinical Microbiology, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University,Beijing 100020, China%Department of Respiratory and Critical Care Medicine , Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University,Beijing 100020, China
• Subjects: Aged; Aged, 80 and over; Critical Illness; Female; Humans; Invasive Pulmonary Aspergillosis - blood; Invasive Pulmonary Aspergillosis - complications; Invasive Pulmonary Aspergillosis - pathology; Male; Mannans - blood; Middle Aged; Prospective Studies; Pulmonary Disease, Chronic Obstructive - blood; Pulmonary Disease, Chronic Obstructive - etiology; Pulmonary Disease, Chronic Obstructive - pathology; 价值; 侵袭性; 半乳甘露聚糖; 危重病人; 慢性阻塞性肺疾病; 曲霉病; 血清; 风险; Aspergillus; galactomannan; prognosis; pulmonary disease,chronic obstructive; invasive pulmonary aspergillosis
• ISSN: 0366-6999; 2542-5641
• DOI: 10.3760/cma.j.issn.0366-6999.20131651

Background Critically ill chronic obstructive pulmonary disease （COPD） patients admitted to an intensive care unit （ICU） due to respiratory failure are at particularly high risk of Aspergillus infection.The serum galactomannan index （GMI） has proven to be one of the prognostic criteria for invasive pulmonary aspergillosis （IPA） in classical immunocompromised patients.However,the prognostic value of serum GMI in critically ill COPD patients needs evaluation.The purpose of this study is to investigate the prognostic value of serum GMI in patients with severe COPD.Methods In this single-center prospective cohort study,serum samples for GMI assay were collected twice a week from the first day of ICU admission to the day of the patients＇ discharge or death.Patients were divided into two groups according to their clinical outcome on the 28th day of their ICU admission.Univariate analysis and survival analysis were tested in these two groups.Results One hundred and fifty-three critically ill COPD patients were included and were divided into survival group （106 cases） and non-survival group （47 cases） according to their outcome.Univariate analysis showed that the highest GMI level during the first week after admission （GMI-high 1st week） was statistically different between the two groups.Independent prognostic factors for poor outcome in severe COPD patients were：GMI-high 1st week ＞0.5 （RR：4.04,95％ CI：2.17-7.51） combined with accumulative dosage of corticosteroids ＞216 mg before the RICU admission （RR：2.25,95％ CI：1.11-4.56） and clearance of creatinine （Ccr） ＜64.31 ml/min （RR：2.48,95％ CI：1.22-5.07）.Conclusions The positive GMI-high 1st week （＞0.5） combined with an accumulative dosage of corticosteroids ＞216 mg before the ICU admission and a low Ccr may predicate a poor outcome of critically ill COPD patients.