J Korean Med Sci.  2012 Jan;27(1):10-15. 10.3346/jkms.2012.27.1.10.

Real-Time Nucleic Acid Sequence-Based Amplification to Predict the Clinical Outcome of Invasive Aspergillosis

• Kim SH
• Park C
• Kwon EY
• Shin NY
• Kwon JC
• Park SH
• Choi SM
• Lee DG
• Choi JH
• Yoo JH

• KMID: 1792972
• DOI: http://doi.org/10.3346/jkms.2012.27.1.10

Abstract

Monitoring the response to therapy for invasive aspergillosis (IA) is essential for the management of patients with hematologic diseases. We evaluated the correlation between the outcome of real-time nucleic acid sequence-based amplification (RTi-NASBA) for Aspergillus 18S rRNA and the clinical outcome of IA. A total of 157 serum samples from 29 patients with IA were tested for RTi-NASBA. The treatment response and mortality were compared with the NASBA outcome (whether the NASBA value was converted to negative or not) at 12 weeks after the start of antifungal therapy. At 12 weeks, there was a moderate correlation between the treatment failure and persistently positive NASBA (kappa = 0.482; P = 0.019). Deaths attributable to IA were more prevalent in patients without negative conversion of NASBA than in those with negative conversion (50% vs 5%; P = 0.013). Significant factors of treatment failure at 12 weeks were the status of hematologic disease (nonremission; P = 0.041) and the NASBA outcome (failure of negative conversion; P = 0.024). Survival was significantly better in patients with negative conversion of NASBA than those with persistently positive values (P = 0.036). This study suggests that the serial monitoring of RTi-NASBA could be useful for prediction of the clinical outcome in hematologic patients with IA.

Keyword

Nucleic Acid Sequence-Based Amplification; Aspergillosis; Treatment Outcome

MeSH Terms

Adolescent
Adult
Aged
Antifungal Agents/therapeutic use
Aspergillosis/*diagnosis/drug therapy/microbiology/mortality
Aspergillus/*genetics/isolation & purification
Base Sequence
Female
Humans
Lung/microbiology
Male
Middle Aged
Predictive Value of Tests
RNA, Ribosomal, 18S/analysis
*Real-Time Polymerase Chain Reaction
Retrospective Studies
Sputum/microbiology
Survival Rate

Figure

• 

  Fig. 1 Cumulative survival of the patients according to the nucleic acid sequence-based amplification (NASBA) outcome.

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