Abstract

Invasive fungal infections (IFI) cause considerable morbidity and mortality in pediatric patients. Serum biomarkers such as 1,3-beta-D glucan (BDG) and galactomannan (GM) have been evaluated for the IFI diagnosis. However, most evidence regarding their utility is derived from studies in adult oncology patients. This systematic review aimed to compare the diagnostic accuracy of BDG and GM individually or in combination for diagnosing IFI in pediatric patients. PubMed, CINAHL, Embase, and Cochrane Library were searched until March 2019 for diagnostic studies evaluating both serum GM and BDG for diagnosing pediatric IFI. The pooled diagnostic odds ratio (DOR), specificity and sensitivity were computed. Receiver operating characteristics (ROC) curve and area under the curve (AUC) were used for summarizing overall assay performance. Six studies were included in the meta-analysis. The summary estimates of sensitivity, specificity, pooled DOR, AUC of the GM assay for proven or probable IFI were 0.74, 0.76, 13.25, and 0.845. The summary estimates of sensitivity, specificity, pooled DOR, AUC of the BDG assay were 0.70, 0.69, 4.3, and 0.722. The combined predictive ability of both tests was reported in two studies (sensitivity: 0.67, specificity: 0.877). Four studies were performed in hematology-oncology patients, while two were retrospective studies from pediatric intensive care units (ICUs). In the subgroup of hematology-oncology patients, DOR of BDG remained similar at 4.25 but increased to 40.28 for GM. We conclude that GM and BDG have a modest performance for identifying IFI in pediatric patients. GM has a better accuracy over BDG. Combining both improves the specificity at the cost of sensitivity.

中文翻译：

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1,3 β-D 葡聚糖和半乳甘露聚糖在儿科患者侵袭性真菌感染诊断中的比较准确性：荟萃分析的系统评价

摘要

侵袭性真菌感染 (IFI) 在儿科患者中引起相当大的发病率和死亡率。血清生物标志物如 1,3-β-D 葡聚糖 (BDG) 和半乳甘露聚糖 (GM) 已被评估用于 IFI 诊断。然而，大多数关于其效用的证据来自对成人肿瘤患者的研究。本系统评价旨在比较 BDG 和 GM 单独或组合用于诊断儿科患者 IFI 的诊断准确性。直到 2019 年 3 月，PubMed、CINAHL、Embase 和 Cochrane 图书馆都被检索了用于评估血清 GM 和 BDG 以诊断儿童 IFI 的诊断研究。计算汇总诊断比值比 (DOR)、特异性和敏感性。接受者操作特征 (ROC) 曲线和曲线下面积 (AUC) 用于总结整体测定性能。六项研究被纳入荟萃分析。对于已证实或可能的 IFI，GM 检测的敏感性、特异性、合并 DOR、AUC 的汇总估计值为 0.74、0.76、13.25 和 0.845。BDG 测定的敏感性、特异性、合并 DOR、AUC 的汇总估计值为 0.70、0.69、4.3 和 0.722。两项研究报告了两种测试的综合预测能力（敏感性：0.67，特异性：0.877）。四项研究是在血液肿瘤患者中进行的，而两项是来自儿科重症监护病房 (ICU) 的回顾性研究。在血液肿瘤患者亚组中，BDG 的 DOR 保持相似，为 4.25，但 GM 增加到 40.28。我们得出结论，GM 和 BDG 在识别儿科患者的 IFI 方面表现不佳。GM 比 BDG 具有更好的准确性。