The Journal of infection · 2015
False-positive Aspergillus galactomannan and its kinetics in allogeneic hematopoietic stem cell transplantation.
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Kimura Shun-Ichi, Akahoshi Yu, Nakano Hirofumi, Harada Naonori, Kameda Kazuaki, Ugai Tomotaka, Wada Hidenori, Yamasaki Ryoko, Ishihara Yuko, Kawamura Koji, Sakamoto Kana, Ashizawa Masahiro, Sato Miki, Terasako-Saito Kiriko, Nakasone Hideki, Kikuchi Misato, Yamazaki Rie, Kanda Junya, Kako Shinichi, Tanihara Aki, Nishida Junji, Kanda Yoshinobu
Аннотация
OBJECTIVES: We evaluated the incidence of and risk factors for false-positive Aspergillus galactomannan (GM) antigenemia in allogeneic hematopoietic stem cell transplantation (HSCT). We also focused on the GM index value and its kinetics.
METHODS: Patients who underwent their first allogeneic HSCT at our center between June 2007 and December 2012 were included (n = 172). Episodes of positive GM tests were classified as either "true-positive", which fulfilled the EORTC criteria for proven or probable invasive aspergillosis (IA), or "false-positive", which was not accompanied by clinical findings. The remaining cases were regarded as "inconclusive".
RESULTS: The one-year cumulative incidences of IA and positive GM tests were 10.1% and 48.1%, respectively. Among 148 episodes of positive GM tests, 97(65.5%), 23(15.5%), and 28(19.0%) were classified as false-positive, true-positive and inconclusive, respectively. In the first episodes of positive GM tests in each patient (false-positive = 67, others = 30), an increase in the GM value in the first two measurements, neutropenia, and use of anti-mold agents at positive GM episode were associated with a significantly lower possibility of false-positive results according to a multivariate analysis.
CONCLUSIONS: A false-positive GM test was frequently seen after allogeneic HSCT. An increase in the GM value may increase its positive predictive value.
METHODS: Patients who underwent their first allogeneic HSCT at our center between June 2007 and December 2012 were included (n = 172). Episodes of positive GM tests were classified as either "true-positive", which fulfilled the EORTC criteria for proven or probable invasive aspergillosis (IA), or "false-positive", which was not accompanied by clinical findings. The remaining cases were regarded as "inconclusive".
RESULTS: The one-year cumulative incidences of IA and positive GM tests were 10.1% and 48.1%, respectively. Among 148 episodes of positive GM tests, 97(65.5%), 23(15.5%), and 28(19.0%) were classified as false-positive, true-positive and inconclusive, respectively. In the first episodes of positive GM tests in each patient (false-positive = 67, others = 30), an increase in the GM value in the first two measurements, neutropenia, and use of anti-mold agents at positive GM episode were associated with a significantly lower possibility of false-positive results according to a multivariate analysis.
CONCLUSIONS: A false-positive GM test was frequently seen after allogeneic HSCT. An increase in the GM value may increase its positive predictive value.