A Mortality Prediction Rule for Hematology Patients with Invasive Aspergillosis Based on Serum Galactomannan Kinetics
In invasive aspergillosis (IA), an early and adequate assessment of the response to the initial antifungal therapy remains problematic. We retrospectively analyzed 206 hematology patients with proven or probable IA, and collected serial serum galactomannan (sGM) values and survival status through we...
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doaj-65cd28f86a4f468d933718cd41cb5d502020-11-25T02:55:11ZengMDPI AGJournal of Clinical Medicine2077-03832020-02-019261010.3390/jcm9020610jcm9020610A Mortality Prediction Rule for Hematology Patients with Invasive Aspergillosis Based on Serum Galactomannan KineticsToine Mercier0Joachim Wera1Louis Y. A. Chai2Katrien Lagrou3Johan Maertens4KU Leuven, Department of Microbiology, Immunology and Transplantation, 3000 Leuven, BelgiumDepartment of Hematology, University Hospitals Leuven, 3000 Leuven, BelgiumDivision of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore and Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, SingaporeKU Leuven, Department of Microbiology, Immunology and Transplantation, 3000 Leuven, BelgiumKU Leuven, Department of Microbiology, Immunology and Transplantation, 3000 Leuven, BelgiumIn invasive aspergillosis (IA), an early and adequate assessment of the response to the initial antifungal therapy remains problematic. We retrospectively analyzed 206 hematology patients with proven or probable IA, and collected serial serum galactomannan (sGM) values and survival status through week 6 and week 12. We created a model for survival at week 6 based on the sGM taken at baseline and on early sGM kinetics. This resulted in a rule predicting that patients with a baseline sGM index >1.4, who failed to lower that index to <0.5 after one week, had a mortality rate of 48.1% at week 6. Conversely, patients presenting with a baseline sGM index ≤1.4 that obtained a negative sGM (<0.5) after one week, had a mortality that was almost five times lower at only 10.1% by week 6. These findings were confirmed in an external cohort from an independent prospective study. In conclusion, sGM kinetics correlate well with treatment outcomes in hematology patients with IA. We present a rule which is easy to use at the bedside and has good accuracy in predicting week 6 survival.https://www.mdpi.com/2077-0383/9/2/610invasive aspergillosisgalactomannankineticsprognosisoutcomemortality |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Toine Mercier Joachim Wera Louis Y. A. Chai Katrien Lagrou Johan Maertens |
spellingShingle |
Toine Mercier Joachim Wera Louis Y. A. Chai Katrien Lagrou Johan Maertens A Mortality Prediction Rule for Hematology Patients with Invasive Aspergillosis Based on Serum Galactomannan Kinetics Journal of Clinical Medicine invasive aspergillosis galactomannan kinetics prognosis outcome mortality |
author_facet |
Toine Mercier Joachim Wera Louis Y. A. Chai Katrien Lagrou Johan Maertens |
author_sort |
Toine Mercier |
title |
A Mortality Prediction Rule for Hematology Patients with Invasive Aspergillosis Based on Serum Galactomannan Kinetics |
title_short |
A Mortality Prediction Rule for Hematology Patients with Invasive Aspergillosis Based on Serum Galactomannan Kinetics |
title_full |
A Mortality Prediction Rule for Hematology Patients with Invasive Aspergillosis Based on Serum Galactomannan Kinetics |
title_fullStr |
A Mortality Prediction Rule for Hematology Patients with Invasive Aspergillosis Based on Serum Galactomannan Kinetics |
title_full_unstemmed |
A Mortality Prediction Rule for Hematology Patients with Invasive Aspergillosis Based on Serum Galactomannan Kinetics |
title_sort |
mortality prediction rule for hematology patients with invasive aspergillosis based on serum galactomannan kinetics |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2020-02-01 |
description |
In invasive aspergillosis (IA), an early and adequate assessment of the response to the initial antifungal therapy remains problematic. We retrospectively analyzed 206 hematology patients with proven or probable IA, and collected serial serum galactomannan (sGM) values and survival status through week 6 and week 12. We created a model for survival at week 6 based on the sGM taken at baseline and on early sGM kinetics. This resulted in a rule predicting that patients with a baseline sGM index >1.4, who failed to lower that index to <0.5 after one week, had a mortality rate of 48.1% at week 6. Conversely, patients presenting with a baseline sGM index ≤1.4 that obtained a negative sGM (<0.5) after one week, had a mortality that was almost five times lower at only 10.1% by week 6. These findings were confirmed in an external cohort from an independent prospective study. In conclusion, sGM kinetics correlate well with treatment outcomes in hematology patients with IA. We present a rule which is easy to use at the bedside and has good accuracy in predicting week 6 survival. |
topic |
invasive aspergillosis galactomannan kinetics prognosis outcome mortality |
url |
https://www.mdpi.com/2077-0383/9/2/610 |
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