151. Performance of Repeated Measures of (1–3)-β-D-Glucan, Mannan Antigen, and Antimannan Antibodies for the Diagnosis of Invasive Candidiasis in ICU Patients: A Preplanned Ancillary Analysis of the EMPIRICUS Randomized Clinical Trial
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Dupuis, Claire, Le Bihan, Clément, Calvet, Laure, Schwebel, Carole, Cornet, Muriel, Hamidfar-Roy, Rebecca, Ciroldi, Magalie, Paugam-Burtz, Clichy Catherine, Foucrier, Arnaud, Navellou, Jean Christophe, Wolff, Michel, Timsit, Jean-Francois, Bouadma, Lila, Mourvillier, Bruno, Sonneville, Romain, Chemam, Sarah, Gruson, Didier, Souweine, Bertrand, Lautrette, Alexandre, Charles, Pierre Emmanuel, BRUYERE, Rémi, Hamet, Maël, Allaouchiche, Bernard, Guillaume, Christian, Ber, Charles-Eric, Prothet, Johanne, Rimmele, Thomas, Argaud, Laurent, Simon, Marie, Cour, Martin, Hernu, Romain, Jaber, Samir, Jung, Boris, Conseil, Mathieu, Coisel, Yannael, Belafia, Fouad, Klouche, Kada, Amigues, Laurent, Machado, Sonia, Serveaux, Marianne, Chastre, Jean, Trouillet, Jean-Louis, Cousson, Joël, Raclot, Pascal, Floch, Thierry, Zeni, Fabrice, Darmon, Michael, Pichon, Matthias, Coudrot, Maud, Ninet, Sebastien, Diconne, Eric, Schlemmer, Benoit, Azoulay, Elie, Lemiale, Virginie, Maziers, Nicolas, Meziani, Ferhat, Schnell, David, Boisrame-Helms, Julie, Neagu-Anca, Raluca, Delabranche, Xavier, Martinet, Olivier, Garrouste-Orgeas, Maité, Misset, Benoit, Brunee, Fabrice, Laurent, Virginie, Lacave, Guillaume, Bedos, Jean-Pierre, Hammi, Khadija, Styfalova, Lenka, Fritzsch, Joelle, Letrou, Sophie, Estevez, Lucie, Devaux, Therese, Dubien, Celine, Bayarassou, Soumia, Faure, Catherine Jouvene, de la Salle, Sylvie, Prades, Albert, Rodriguez, Annie, Meur, Pierre, Warchol, Magda, El Haouari, Hanane, Theodose, Igor, Fournier, Julien, Cavelot, Sebastien, Kodja, Lilia Bakir, Faure, Marie Joyeux, Tacco, Frédéric, Roos, Sonia, Dupre, Karima, Abazid, Malek, Essert, Michele, Arnaud, Philippe, Papy, Emmanuelle, Ghezzoul, Bellabes, Gerbouin, Olivier, Peccoux, Sandrine Corny, Fagnoni, Philippe, Millaret, Anne, Pivot, Christine, Gerard, Cecile, Breuker, Cyril, Castet, Audrey, Charbonnier, Fanny, Legrand, Maryline, Mordini, Julia, Chambrin, Isabelle Madeleine, Clauss, Anne Hutt, Cherifi, Mohamed, Pattyn, Anne, Cornet, Murielle, Maubon, Daniele, Benveniste, Eliane, Grenouillet, Frédéric, Chochillon, Christian, Accoberry, Isabelle, Pons, Denis, Mrozek, Natacha, Dalle, Frédéric, Picot, Stephane, Beyerle, Francoise, Bienvenu, Anne-Lise, Bourgeois, Nathalie, Fekkar, Arnaud, Toubas, Dominique, Raberin, Hélène, Candolfi, Ermanno, Bru, Valérie, Kitzis, Marie Dominique, Senghor, Yaye, Palette, Catherine, Ruckly, Stéphane, Vesin, Aurélien, Zahar, Jean-Ralph, Mira, Jean-Paul, Larrey, Dominique, Zarski, Jean-Pierre, Schir, Edith, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
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0301 basic medicine ,medicine.medical_specialty ,medicine.drug_class ,[SDV]Life Sciences [q-bio] ,030106 microbiology ,Population ,Antibiotics ,Gastroenterology ,Major Articles ,law.invention ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Intensive care ,Internal medicine ,(1 ,Medicine ,030212 general & internal medicine ,education ,(1,3)-β-D-glucan ,education.field_of_study ,business.industry ,competing risk models ,Repeated measures design ,invasive candidiasis ,medicine.disease ,Intensive care unit ,3)-β-D-glucan ,3. Good health ,AcademicSubjects/MED00290 ,Infectious Diseases ,Oncology ,Cohort ,business - Abstract
Background We aimed to assess the prognostic value of repeated measurements of serum (1–3)-β-D-glucan (BDG), mannan-antigen (mannan-Ag), and antimannan antibodies (antimannan-Ab) for the occurrence of invasive candidiasis (IC) in a high-risk nonimmunocompromised population. Methods This was a preplanned ancillary analysis of the EMPIRICUS Randomized Clinical Trial, including nonimmunocompromised critically ill patients with intensive care unit–acquired sepsis, multiple Candida colonization, and multiple organ failure who were exposed to broad-spectrum antibacterial agents. BDG (>80 and >250 pg/mL), mannan-Ag (>125 pg/mL), and antimannan-Ab (>10 AU) were collected repeatedly. We used cause-specific hazard models. Biomarkers were assessed at baseline in the whole cohort (cohort 1). Baseline covariates and/or repeated measurements and/or increased biomarkers were then studied in the subgroup of patients who were still alive at day 3 and free of IC (cohort 2). Results Two hundred thirty-four patients were included, and 215 were still alive and free of IC at day 3. IC developed in 27 patients (11.5%), and day 28 mortality was 29.1%. Finally, BDG >80 pg/mL at inclusion was associated with an increased risk of IC (CSHR[IC], 4.67; 95% CI, 1.61–13.5) but not death (CSHR[death], 1.20; 95% CI, 0.71–2.02). Conclusions Among high-risk patients, a first measurement of BDG >80 pg/mL was strongly associated with the occurrence of IC. Neither a cutoff of 250 pg/mL nor repeated measurements of fungal biomarkers seemed to be useful to predict the occurrence of IC. The cumulative risk of IC in the placebo group if BDG >80 pg/mL was 25.39%, which calls into question the efficacy of empirical therapy in this subgroup.
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- 2021