Early Serum Galactomannan Trend as a Predictor of Outcome of Invasive Aspergillosis

• DOI: 10.1128/jcm.06513-11
• Publication Date: 2012-05-03T03:45:48Z
• Authors: Louis Y. A. Chai; Bart-Jan Kullberg; Elizabeth M. Johnson; Steven Teerenstra; Lay Wai Khin; Alieke G. Vonk; Johan Maertens; Olivier Lortholary; Peter J. Donnelly; Haran T. Schlamm; Peter F. Troke; Mihai G. Netea; Raoul Herbrecht
• Keywords: Galactomannan

The monitoring and prediction of treatment responses to invasive aspergillosis (IA) are difficult. We determined whether serum galactomannan index (GMI) trends early in the course disease may be useful predicting eventual clinical outcomes. For subjects recruited into multicenter Global Aspergillosis Study, serial GMIs were measured at baseline weeks 1, 2, 4 following antifungal treatment. Clinical response survival 12 outcome measures. GMI analyzed by using generalized estimation equation approach. cutoffs evaluated receiver-operating curve analyses incorporating pre- posttest probabilities. Of 202 study patients diagnosed with IA, 71 (35.1%) had a ≥ 0.5. Week 1 was significantly lower for responders week than nonresponders (GMIs 0.62 ± 0.12 1.15 0.22, respectively; P = 0.035). A reduction >35% between predicted probability satisfactory response. IA pretreatment <0.5 (n 131; 64.9%), ought remain low during treatment, rising absolute >0.5 2 despite heralded poor outcome. Here, every 0.1-unit increase increased likelihood an unsatisfactory 21.6% (P 0.018). In summary, outcomes anticipated charting first therapy. These findings have significant implications management IA.