Methods: We evaluated the diagnostic performance of GM ELISA, and Aspergillus PCR by using bronchoalveolar lavage fluid samples and blood samples obtained at the same day from a total of 53 immunocompromised patients (16 with probable/proven IPA and 37 with no evidence of IPA according to the revised EORTC/MSG criteria; 38 patients with hematological malignancies prospectively enrolled at the Medical University of Graz, Austria, 15 patients with mixed underlying diseases at the Mannheim University Hospital). Patients with possible IPA were excluded from this analysis.
Results: Results are displayed in the table. Best sensitivity (81%) for detecting proven/probable IPA was achieved when Aspergillus PCR, BAL-culture and serum-GM were combined (specificity 92%).
Conclusion: While sensitivities of the evaluated diagnostic tests – when interpreted on their own - were low in BAL and even lower in blood, sensitivities improved markedly when diagnostic tests were combined.
Table 1:Sensitivity (n=16), specificity (n=37), positive predictive value (PPV), negative predictive value (NPV) and diagnostic odds ratio (95% confidence interval) for Aspergillus PCR, GM (Cut-off: >0,5 optical density index) and culture for diagnosing probable/proven vs. no IPA (sample material stated in parenthesis)
|Test methods||Sensitivity [%]||Specificity [%]||PPV [%]||NPV [%]||DOR|
|PCR (BAL)||43||100||100||80||59.2 [3.1-1,1132]|
|GM (BAL)||38||92||67||77||6.8 [1.4-32.2]|
|GM (serum)||31||100||100||77||38.9 [1,8-699.3]|
|PCR (BAL) and/or GM (BAL)||69||92||79||87||24.9 [5.1-121.7]|
|PCR (BAL) and/or GM (serum)||63||100||100||86||121.2 [6.3-2,332]|
|Culture (BAL)||25||100||100||76||27.0 [1.4-537.9]|
|PCR (BAL) and/or GM (BAL) and/or culture (BAL)||75||92||80||90||34 [6.6-174.5]|
|PCR (BAL) and/or GM (serum) and/or culture (BAL||81||92||81||92||49.11 [8.8-275.3]|
D. Buchheidt, None
J. Prattes, None
R. Krause, None
A. Woelfler, None
F. Prueller, None
B. Spiess, None
M. Hoenigl, Gilead: Funding Applicant , Grant Funding
T. Boch, None