Validation of serum galactomannan antigen assay for invasive pulmonary aspergillosis mortality outcome prediction.
Journal
Microbiology spectrum
Journal Volume
13
Journal Issue
12
Start Page
1
End Page
11
ISSN
2165-0497
Date Issued
2025-10-27
Author(s)
Wu, Trent Chang-Wei
Lin, Chen Chieh
Chen, Jung-Yueh
Abstract
The galactomannan antigen assay is crucial in diagnosing invasive pulmonary aspergillosis (IPA). However, its clinical utility as a prognostic factor has not yet been fully validated. Patients with proven or probable invasive pulmonary aspergillosis (IPA) who had a serum galactomannan enzyme immunoassay optical density index (sGMI) (Platelia Aspergillus Antigen immunoassay, Bio-Rad, CA, USA) result between 2013 and 2020 at a tertiary referral center were identified. We conducted a systematic review and identified studies using static or kinetic sGMI markers for IPA prognosis. A multivariable logistic regression model was used to validate these sGMI markers separately for 30-day, 90-day, and in-hospital mortality. Our study included 268 IPA patients (14 proven IPA, 254 probable IPA). The 30-day, 90-day, and in-hospital mortality were 38.1%, 60.1%, and 61.6% respectively. A total of 12 different sGMI predictive markers were included for validation. In our multivariable logistic regression, baseline sGMI ≥2 at IPA diagnosis was associated with 30-day mortality (adjusted odds ratio [aOR] 2.06; 95% confidence interval [CI], 1.16–3.66; P = 0.013), 90-day mortality (aOR 2.33; 95% CI, 1.29–4.21; P = 0.005), and in-hospital mortality (aOR 2.99; 95% CI, 1.62–5.51; P < 0.001). A day 7 sGMI ≥1.5 was also associated with 30-day mortality (aOR 2.34; 95% CI, 1.09–5.02; P = 0.029), 90-day mortality (aOR 2.24; 95% CI, 1.10–4.58; P = 0.027), and in-hospital mortality (aOR 2.30; 95% CI, 1.12–4.71; P = 0.023). No kinetic sGMI marker reached statistical significance for predicting all three outcomes. A baseline sGMI ≥2 at diagnosis can be used as a prognostic marker for IPA mortality outcomes. A day 7 sGMI ≥1.5 during treatment serves as an additional prognostic marker.
Subjects
biomarker
galactomannan
invasive pulmonary aspergillosis
prognosis
survival analysis
Type
journal article