Source:http://linkedlifedata.com/resource/pubmed/id/15352990
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| Predicate | Object |
|---|---|
| rdf:type | |
| lifeskim:mentions | |
| pubmed:issue |
6
|
| pubmed:dateCreated |
2004-9-8
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| pubmed:abstractText |
The recent advent of an improved commercial serum enzyme-linked immunosorbent assay (ELISA) for the detection of circulating galactomannan (GM), a major constituent of Aspergillus cell walls, has contributed to the diagnosis of invasive aspergillosis (IA) in many haematology and transplant centres. However, the optimal threshold for positivity remains a matter of debate. We prospectively evaluated the impact of lowering the cut-off in 124 neutropenic episodes with a high pretest probability for IA. Two new cut-off points, lower than previously accepted, are proposed: (a) a 'static' cut-off at 0.8 and (b) a 'dynamic' cut-off at 0.5. A single assay with an optical density (OD) index > or = 0.8 warrants the initiation of anti-Aspergillus therapy. A further lowering of the 'static' threshold seems not clinically feasible given the drop in positive predictive value (PPV). However, the demonstration of at least two sequential sera with an OD > or = 0.5 ('dynamic' threshold) increased the specificity and the PPV to 98.6% and the efficiency to 98%. Applying both cut-offs to a subgroup of 21 'possible' fungal infections further identified and upgraded six cases of IA. However, the clinical benefit of lower cut-offs (particularly for earlier diagnosis) depends upon the kinetics of antigenaemia and the intensity of serum sampling.
|
| pubmed:language |
eng
|
| pubmed:journal | |
| pubmed:citationSubset |
IM
|
| pubmed:chemical | |
| pubmed:status |
MEDLINE
|
| pubmed:month |
Sep
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| pubmed:issn |
0007-1048
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| pubmed:author | |
| pubmed:issnType |
Print
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| pubmed:volume |
126
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| pubmed:owner |
NLM
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| pubmed:authorsComplete |
Y
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| pubmed:pagination |
852-60
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| pubmed:dateRevised |
2004-11-17
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| pubmed:meshHeading |
pubmed-meshheading:15352990-Adolescent,
pubmed-meshheading:15352990-Adult,
pubmed-meshheading:15352990-Aged,
pubmed-meshheading:15352990-Aspergillosis,
pubmed-meshheading:15352990-Biological Markers,
pubmed-meshheading:15352990-Enzyme-Linked Immunosorbent Assay,
pubmed-meshheading:15352990-Feasibility Studies,
pubmed-meshheading:15352990-Female,
pubmed-meshheading:15352990-Hematologic Neoplasms,
pubmed-meshheading:15352990-Hematopoietic Stem Cell Transplantation,
pubmed-meshheading:15352990-Humans,
pubmed-meshheading:15352990-Male,
pubmed-meshheading:15352990-Mannans,
pubmed-meshheading:15352990-Middle Aged,
pubmed-meshheading:15352990-Neutropenia,
pubmed-meshheading:15352990-Opportunistic Infections,
pubmed-meshheading:15352990-Prospective Studies,
pubmed-meshheading:15352990-Sensitivity and Specificity
|
| pubmed:year |
2004
|
| pubmed:articleTitle |
Prospective clinical evaluation of lower cut-offs for galactomannan detection in adult neutropenic cancer patients and haematological stem cell transplant recipients.
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| pubmed:affiliation |
Department of Haematology, University Hospital Gasthuisberg, Leuven, Belgium. johan.maertens@uz.kuleuven.ac.be
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| pubmed:publicationType |
Journal Article,
Evaluation Studies
|