Prognostic Features of Galactomannan Antigenemia in Galactomannan-Positive Invasive Aspergillosis

• Published in: Journal of Clinical Microbiology Vol. 48; no. 4; pp. 1255 - 1260
• Main Authors: Koo, Sophia, Bryar, Julie M, Baden, Lindsey R, Marty, Francisco M
• Format: Journal Article
• Language: English
• Published: United States American Society for Microbiology 01.04.2010; American Society for Microbiology (ASM)
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Antifungal Agents - therapeutic use; Antigens, Fungal - blood; Aspergillosis - diagnosis; Aspergillosis - drug therapy; Aspergillosis - mortality; Aspergillus; Female; Humans; Immunoassay - methods; Male; Mannans - blood; Middle Aged; Mycology; Prognosis; Serum - chemistry; Time Factors; Treatment Outcome; Young Adult
• ISSN: 0095-1137; 1098-660X
• DOI: 10.1128/JCM.02281-09

Prognostic features of serum galactomannan (GM) remain poorly defined in patients with GM-positive invasive aspergillosis (GPA). We identified 93 patients with proven or probable invasive aspergillosis (IA) and GM values of ≥0.50 from January 2005 to March 2009. We used Cox modeling of time to 6- and 12-week mortality for the GM level at the time of diagnosis (GM₀), GM decay in the week following diagnosis in 72 patients with ≥2 GM values, other predictors of mortality, and antifungal use during the week following diagnosis. Six-week mortality was 55% in the whole cohort and 43% in patients with ≥2 GM determinations. The hazard ratio (HR) of GM₀ per unit increase and 1-week GM decay per unit decline per week were 1.25 (95% confidence interval [CI], 1.01 to 1.54; P = 0.04) and 0.78 (95% CI, 0.63 to 0.96; P = 0.02), respectively, adjusting for other predictors of IA mortality; these values remained stable after adjusting for antifungal use and were predictive of all-cause mortality at 12 weeks with similar adjusted HR values. We conclude that the combination of GM₀ and 1-week GM decay is predictive of all-cause mortality in patients with GPA, independent of other traditional risk factors for mortality and antifungal exposure, supporting GM decay as a potential surrogate endpoint for future antifungal therapeutic trials.