Ann Lab Med.  2023 Jul;43(4):381-385. 10.3343/alm.2023.43.4.381.

Clinical Sensitivity of the (1–3)-β-D-glucan Test for Predicting Candidemia

• Lee YW
• Lim SY
• Jin S
• Park HJ
• Sung H
• Kim MN
• Bae S
• Jung J
• Kim MJ
• Kim SH
• Lee SO
• Choi SH
• Kim YS
• Chong YP

• KMID: 2551956
• DOI: http://doi.org/10.3343/alm.2023.43.4.381

Abstract

The sensitivity of the (1–3)-β-D-glucan (BDG) diagnostic test for candidemia varies in different clinical settings, and its usefulness in early diagnosis of candidemia is suboptimal. We evaluated the sensitivity of the test for early candidemia prediction. All adult patients with culture-proven candidemia who underwent a serum Goldstream Fungus (1–3)-β-D-Glucan Test within seven days prior to candidemia onset at a tertiary referral hospital between January 2017 and May 2021 were included. Any-positive BDG results within seven days prior to candidemia onset were obtained in 38 out of 93 (40.9%) patients. The positive rate increased when the test was performed near the day of candidemia onset (P=0.04) but reached only 52% on the day of candidemia onset. We observed no significant differences between BDG-positive and -negative groups in terms of underlying disease, risk factors for candidemia, clinical presentation, origin of candidemia, and 30-day mortality. Candida albicans was significantly associated with positive BDG results than with all-negative BDG results (P=0.04). The Goldstream BDG test is unreliable for candidemia prediction because of its low sensitivity. Negative BDG results in patients with a high risk of invasive candidiasis should be interpreted with caution.

Keyword

Candidemia, (1–3)-β-D-glucan; Sensitivity; Candida albicans; Early diagnosis; Systemic candidiasis

Figure

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  Fig. 1 Proportions and distributions of the BDG results. (A) Proportions of positive BDG results at different time points before candidemia onset. The proportion of positive BDG results increased over time (P=0.04 for trend). (B) Distribution of the BDG values. Values above the maximum detectable level (1,000 pg/mL) were recorded as >1,000 pg/mL. The cut-off value for a positive BDG test was 80.0 pg/mL. Abbreviation: BDG, (1–3)-β-D-glucan.

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  Fig. 2 Distribution of BDG values according to Candida species. Values above the maximum detectable level (1,000 pg/mL) were recorded as >1,000 pg/mL. The cut-off value for a positive BDG test was 80.0 pg/mL. Interspecies differences in BDG values were not statistically significant. The horizontal lines denote the median of positive BDG results. Abbreviation: BDG, (1–3)-β-D-glucan.

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