Monocyte human leukocyte antigen-DR but not β-d-glucan may help early diagnosing invasive Candida infection in critically ill patients
Abstract Background Precision medicine risk stratification is desperately needed to both avoid systemic antifungals treatment delay and over prescription in the critically ill with risk factors. The aim of the present study was to explore the combination of host immunoparalysis biomarker (monocyte h...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2021-08-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13613-021-00918-1 |
| _version_ | 1818645071098019840 |
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| author | Boris Jung Clément Le Bihan Pierre Portales Nathalie Bourgeois Thierry Vincent Laurence Lachaud Gerald Chanques Matthieu Conseil Philippe Corne Pablo Massanet Jean François Timsit Samir Jaber |
| author_facet | Boris Jung Clément Le Bihan Pierre Portales Nathalie Bourgeois Thierry Vincent Laurence Lachaud Gerald Chanques Matthieu Conseil Philippe Corne Pablo Massanet Jean François Timsit Samir Jaber |
| author_sort | Boris Jung |
| collection | DOAJ |
| description | Abstract Background Precision medicine risk stratification is desperately needed to both avoid systemic antifungals treatment delay and over prescription in the critically ill with risk factors. The aim of the present study was to explore the combination of host immunoparalysis biomarker (monocyte human leukocyte antigen-DR expression (mHLA-DR)) and Candida sp wall biomarker β-d-glucan in risk stratifying patients for secondary invasive Candida infection (IC). Methods Prospective observational study. Two intensive care units (ICU). All consecutive non-immunocompromised septic shock patients. Serial blood samples (n = 286) were collected at day 0, 2 and 7 and mHLA-DR and β-d-glucan were then retrospectively assayed after discharge. Secondary invasive Candida sp infection occurrence was then followed at clinicians’ discretion. Results Fifty patients were included, 42 (84%) had a Candida score equal or greater than 3 and 10 patients developed a secondary invasive Candida sp infection. ICU admission mHLA-DR expression and β-d-glucan (BDG) failed to predict secondary invasive Candida sp infection. Time-dependent cause-specific hazard ratio of IC was 6.56 [1.24–34.61] for mHLA-DR < 5000 Ab/c and 5.25 [0.47–58.9] for BDG > 350 pg/mL. Predictive negative value of mHLA-DR > 5000 Ab/c and BDG > 350 pg/mL combination at day 7 was 81% [95% CI 70–92]. Conclusions This study suggests that mHLA-DR may help predicting IC in high-risk patients with septic shock. The added value of BDG and other fungal tests should be regarded according to the host immune function markers. |
| first_indexed | 2024-12-17T00:24:54Z |
| format | Article |
| id | doaj.art-715c9db1675d40f0a8f15322e57427ba |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-17T00:24:54Z |
| publishDate | 2021-08-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-715c9db1675d40f0a8f15322e57427ba2022-12-21T22:10:29ZengSpringerOpenAnnals of Intensive Care2110-58202021-08-0111111110.1186/s13613-021-00918-1Monocyte human leukocyte antigen-DR but not β-d-glucan may help early diagnosing invasive Candida infection in critically ill patientsBoris Jung0Clément Le Bihan1Pierre Portales2Nathalie Bourgeois3Thierry Vincent4Laurence Lachaud5Gerald Chanques6Matthieu Conseil7Philippe Corne8Pablo Massanet9Jean François Timsit10Samir Jaber11Medical Intensive Care Unit, Montpellier University and Montpellier University Health Care CenterDépartement des Maladies Infectieuses et Tropicales, Montpellier University and Montpellier University Health Care CenterImmunology Department, Montpellier University and Montpellier University Health Care CenterDépartement de Parasitologie-Mycologie, Montpellier University and Montpellier University Health Care Center, UMR MivegecImmunology Department, Montpellier University and Montpellier University Health Care CenterDépartement de Parasitologie-Mycologie, Montpellier University and Montpellier University Health Care Center, UMR MivegecPhyMedExp Laboratory, Montpellier University, INSERM, CNRS, CHRU MontpellierSaint Eloi Department of Anesthesiology and Critical Care Medicine, Montpellier University and Montpellier University Health Care CenterMedical Intensive Care Unit, Montpellier University and Montpellier University Health Care CenterDepartment of Anesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire NîmesAPHP Hôpital Bichat-Claude Bernard, Paris-Diderot UniversityPhyMedExp Laboratory, Montpellier University, INSERM, CNRS, CHRU MontpellierAbstract Background Precision medicine risk stratification is desperately needed to both avoid systemic antifungals treatment delay and over prescription in the critically ill with risk factors. The aim of the present study was to explore the combination of host immunoparalysis biomarker (monocyte human leukocyte antigen-DR expression (mHLA-DR)) and Candida sp wall biomarker β-d-glucan in risk stratifying patients for secondary invasive Candida infection (IC). Methods Prospective observational study. Two intensive care units (ICU). All consecutive non-immunocompromised septic shock patients. Serial blood samples (n = 286) were collected at day 0, 2 and 7 and mHLA-DR and β-d-glucan were then retrospectively assayed after discharge. Secondary invasive Candida sp infection occurrence was then followed at clinicians’ discretion. Results Fifty patients were included, 42 (84%) had a Candida score equal or greater than 3 and 10 patients developed a secondary invasive Candida sp infection. ICU admission mHLA-DR expression and β-d-glucan (BDG) failed to predict secondary invasive Candida sp infection. Time-dependent cause-specific hazard ratio of IC was 6.56 [1.24–34.61] for mHLA-DR < 5000 Ab/c and 5.25 [0.47–58.9] for BDG > 350 pg/mL. Predictive negative value of mHLA-DR > 5000 Ab/c and BDG > 350 pg/mL combination at day 7 was 81% [95% CI 70–92]. Conclusions This study suggests that mHLA-DR may help predicting IC in high-risk patients with septic shock. The added value of BDG and other fungal tests should be regarded according to the host immune function markers.https://doi.org/10.1186/s13613-021-00918-1Beta D-glucanmHLA-DRCandidiasisSeptic shock |
| spellingShingle | Boris Jung Clément Le Bihan Pierre Portales Nathalie Bourgeois Thierry Vincent Laurence Lachaud Gerald Chanques Matthieu Conseil Philippe Corne Pablo Massanet Jean François Timsit Samir Jaber Monocyte human leukocyte antigen-DR but not β-d-glucan may help early diagnosing invasive Candida infection in critically ill patients Annals of Intensive Care Beta D-glucan mHLA-DR Candidiasis Septic shock |
| title | Monocyte human leukocyte antigen-DR but not β-d-glucan may help early diagnosing invasive Candida infection in critically ill patients |
| title_full | Monocyte human leukocyte antigen-DR but not β-d-glucan may help early diagnosing invasive Candida infection in critically ill patients |
| title_fullStr | Monocyte human leukocyte antigen-DR but not β-d-glucan may help early diagnosing invasive Candida infection in critically ill patients |
| title_full_unstemmed | Monocyte human leukocyte antigen-DR but not β-d-glucan may help early diagnosing invasive Candida infection in critically ill patients |
| title_short | Monocyte human leukocyte antigen-DR but not β-d-glucan may help early diagnosing invasive Candida infection in critically ill patients |
| title_sort | monocyte human leukocyte antigen dr but not β d glucan may help early diagnosing invasive candida infection in critically ill patients |
| topic | Beta D-glucan mHLA-DR Candidiasis Septic shock |
| url | https://doi.org/10.1186/s13613-021-00918-1 |
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