Utility of serum Aspergillus-galactomannan antigen to evaluate the risk of severe acute exacerbation in chronic obstructive pulmonary disease

• Published in: PloS one Vol. 13; no. 6; p. e0198479
• Main Authors: Yoshimura, Katsuhiro, Suzuki, Yuzo, Inoue, Yusuke, Nishimoto, Koji, Mori, Kazutaka, Karayama, Masato, Hozumi, Hironao, Furuhashi, Kazuki, Enomoto, Noriyuki, Fujisawa, Tomoyuki, Nakamura, Yutaro, Inui, Naoki, Yokomura, Koushi, Imokawa, Shiro, Suda, Takafumi
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 05.06.2018; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Aged, 80 and over; Analysis; Antigens; Antigens, Fungal - blood; Aspergillosis - diagnosis; Aspergillosis - immunology; Aspergillus; Aspergillus - immunology; Biology and Life Sciences; Bone marrow; Bronchiectasis; Cell walls; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Computed tomography; Confidence intervals; Cysts; Development and progression; Diagnosis; Diagnostic systems; Disease; Disease Progression; Female; Hospitals; Humans; Internal medicine; Level (quantity); Lung diseases; Male; Mannans - blood; Measurement methods; Medicine; Medicine and Health Sciences; Microbiomes; Middle Aged; Multivariate analysis; Obstructive lung disease; Pathogenesis; Patients; Prevention; Propensity Score; Pulmonary Disease, Chronic Obstructive - immunology; Pulmonary Disease, Chronic Obstructive - microbiology; Quality of life; Rank tests; Respiratory diseases; Retrospective Studies; Risk assessment; Risk factors; Serum levels; Severity of Illness Index; Transplants & implants; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0198479

Recent studies have shown that the microbiome, namely Aspergillus species, play a previously unrecognized role in both stable and exacerbated chronic obstructive pulmonary disease (COPD). Galactomannan is a major component of the Aspergillus cell wall that has been widely used as a diagnostic marker. To explore whether serum levels of Aspergillus-galactomannan antigen could be used to evaluate the risk of severe acute exacerbation of COPD (AE-COPD). We measured the Aspergillus-galactomannan antigen levels of 191 patients with stable COPD, and examined its clinical relevance including AE-COPD. There were 77 (40.3%) patients who were positive for serum Aspergillus-galactomannan antigen (≥0.5). High Aspergillus-galactomannan antigen level (≥0.7) was associated with older age and presence of bronchiectasis and cysts on computed tomography images. Compared to patients with low Aspergillus-galactomannan antigen level (<0.7), patients with high Aspergillus-galactomannan antigen level had significantly higher incidence of severe AE-COPD (P = 0.0039, Gray's test) and respiratory-related mortality (P = 0.0176, log-rank test). Multivariate analysis showed that high Aspergillus-galactomannan antigen level was independently associated with severe AE-COPD (hazard ratio, 2.162; 95% confidence interval, 1.267-3.692; P = 0.005). Serum Aspergillus-galactomannan antigen was detected in patients with COPD, and elevated serum Aspergillus-galactomannan antigen was associated with severe AE-COPD.