1334. Elevated Serum Beta-D-Glucan (BDG) As A Marker For Chemotherapy-induced Mucosal Barrier Injury (MBI) In Adults With Hematologic Malignancies: A Retrospective Analysis.  
Session: Oral Abstract Session: Fungal Pathogenesis, Virulence, and Anti-fungal Therapy
Saturday, October 22, 2011: 1:45 PM
Room: 151AB
Background: MBI is a common and serious complication of cancer chemotherapy at times involving the entire gastrointestinal tract (GIT). However, no markers exist to evaluate its severity. BDG is a fungal cell wall constituent and serves as a diagnostic marker for invasive fungal infection (IFI). Abnormally elevated serum BDG levels in absence of IFI are common among cancer patients receiving chemotherapy. We hypothesized that circulating BDG may result from translocation of gut flora among such patients and represents as a marker of intestinal MBI. Methods: We reviewed the medical records of adult cancer patients treated for candidemia at UAMS between June 2008 and September 2010. All patients with resolved candidemia had then undergone concomitant serial monitoring with blood cultures and BDG and abdominal CT scans (as an objective marker of MBI). Other known causes of elevated BDG values were excluded. BDG level was determined by the Fungitell Assay (Associates of Cape Cod Inc., MA, USA). The performance of BDG as a marker of MBI was done by calculating the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), the area under the curve of the receiver operating characteristics (AUC ROC) and the likelihood ratio (LR+, LR –) using two consecutive BDG cut off value of ≥80 pg/ml. Fisher’s Exact test was used for all the analyses. Results:  27 episodes (17 patients, most with myeloma) fulfilled our inclusion criteria including abdominal CT scans. Radiological evidence of intestinal MBI was present in 16 episodes including enteritis (E, n=10), colitis (C, n= 4) and enterocolitis (EC, n=2). Results are shown in Table 1. Conclusion: This preliminary analysis suggests that abnormally elevated circulating BDG levels may serve as a surrogate maker of intestinal MBI in adult cancer patients receiving chemotherapy.

Table 1: Test performance of circulating BDG as marker for radiographically proven intestinal MBI

 

Sensitivity

(%, 95%CI)

Specificity

(%, 95%CI)

PPV

(%, 95%CI)

NPV

(%, 95%CI)

ROC

(n, 95%CI)

LR +

 

LR -

E + EC + C

43

(0.20-0.69)

81

(0.47-0.96)

78

(0.40-0.96)

50

(0.26-0.73)

.638

 

2.4

 

0.68

E+ EC only

50

(0.22-0.77)

81

(0.47-0.96)

75

(0.35-0.95)

61

(0.33-1.1)

.675

2.7

0.61

 


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Zainab Shahid, M.D.1, Naveen Sanath kumar, M.D1, Alejandro Restrepo, M.D.1, Sajjad Haider, M.D.1, Jameel Muzaffar1, Monica Grazziutti, MD1, Marcio Nucci, MD2 and Elias Anaissie, MD1, (1)The Myeloma Institute for Research and Therapy/University of Arkansas for Medical Sciences, Little Rock, AR, (2)Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro - RJ , Brazil

Disclosures:

Z. Shahid, None

N. Sanath kumar, None

A. Restrepo, None

S. Haider, None

J. Muzaffar, None

M. Grazziutti, None

M. Nucci, Pfizer: Board Member, Consultant, Grant Investigator, Scientific Advisor and Speaker's Bureau, Consulting fee, Educational grant, Research grant and Speaker honorarium
Merck: Board Member, Consultant, Grant Investigator and Scientific Advisor, Consulting fee, Educational grant and Speaker honorarium
Astellas: Board Member, Consultant and Scientific Advisor, Consulting fee and Speaker honorarium

E. Anaissie, None

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