Establishing Aspergillus-Specific IgG Cut-Off Level for Chronic Pulmonary Aspergillosis Diagnosis: Multicenter Prospective Cohort Study
Objectives: <i>Aspergillus</i>-specific IgG (<i>Asp</i>-IgG) cut-off level in diagnosing chronic pulmonary aspergillosis (CPA) remains unknown. Methods: We prospectively recruited participants with clinical suspicion of CPA in three centers in Taiwan during 2019 June to 2020...
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MDPI AG
2021-06-01
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| Series: | Journal of Fungi |
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| Online Access: | https://www.mdpi.com/2309-608X/7/6/480 |
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| author | Meng-Rui Lee Hung-Ling Huang Li-Ta Keng Hsu-Liang Chang Chau-Chyun Sheu Pin-Kuei Fu Jann-Yuan Wang Inn-Wen Chong Jin-Yuan Shih Chong-Jen Yu |
| author_facet | Meng-Rui Lee Hung-Ling Huang Li-Ta Keng Hsu-Liang Chang Chau-Chyun Sheu Pin-Kuei Fu Jann-Yuan Wang Inn-Wen Chong Jin-Yuan Shih Chong-Jen Yu |
| author_sort | Meng-Rui Lee |
| collection | DOAJ |
| description | Objectives: <i>Aspergillus</i>-specific IgG (<i>Asp</i>-IgG) cut-off level in diagnosing chronic pulmonary aspergillosis (CPA) remains unknown. Methods: We prospectively recruited participants with clinical suspicion of CPA in three centers in Taiwan during 2019 June to 2020 August. Serum <i>Aspergillus fumigatus</i>-specific IgG (<i>Asp</i>-IgG) (Phadia, Uppsala, UPPS, Sweden) was examined. Optimal cut-off level was determined by Youden’s index and validated. Results: A total of 373 participants were recruited. In the derivation cohort (<i>n</i> = 262), <i>Asp</i>-IgG had an area under the receiver-operating-characteristic curve (AUC) of 0.832. The optimal cut-off level was 40.5 mgA/L. While applying this cut-off level to the validation cohort (<i>n</i> = 111), the sensitivity and specificity were 86.7% and 80.2%. Lowering the cut-off level from 40.5 to 27 mgA/L, the sensitivity was steady (30/36, 83.3% to 31/36, 86.1%) while specificity dropped from 81.9% (276/337) to 63.5% (214/337). Restricting CPA diagnosis to only chronic cavitary pulmonary aspergillosis (CCPA) and chronic fibrosing pulmonary aspergillosis (CFPA) yielded a cut-off level of 42.3 mgA/L in the derivation cohort with a sensitivity of 100% and specificity of 84.4% in the validation cohort. Conclusions: Serum <i>Asp</i>-IgG performs well for CPA diagnosis and provides a low false-positive rate when using a higher cut-off level (preferably around 40 mgA/L). |
| first_indexed | 2024-03-10T10:27:50Z |
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| institution | Directory Open Access Journal |
| issn | 2309-608X |
| language | English |
| last_indexed | 2024-03-10T10:27:50Z |
| publishDate | 2021-06-01 |
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| series | Journal of Fungi |
| spelling | doaj.art-e9cd2c72463249cd8ea3d3111e5de62f2023-11-21T23:55:41ZengMDPI AGJournal of Fungi2309-608X2021-06-017648010.3390/jof7060480Establishing Aspergillus-Specific IgG Cut-Off Level for Chronic Pulmonary Aspergillosis Diagnosis: Multicenter Prospective Cohort StudyMeng-Rui Lee0Hung-Ling Huang1Li-Ta Keng2Hsu-Liang Chang3Chau-Chyun Sheu4Pin-Kuei Fu5Jann-Yuan Wang6Inn-Wen Chong7Jin-Yuan Shih8Chong-Jen Yu9Department of Internal Medicine, National Taiwan University Hospital, Taipei 10002, TaiwanDepartment of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 80145, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital, Taipei 10002, TaiwanDepartment of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 80145, TaiwanDivision of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Kaohsiung 80708, TaiwanDepartment of Critical Care Medicine, Taichung Veterans General Hospital, Taichung 40705, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital, Taipei 10002, TaiwanDivision of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Kaohsiung 80708, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital, Taipei 10002, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital, Taipei 10002, TaiwanObjectives: <i>Aspergillus</i>-specific IgG (<i>Asp</i>-IgG) cut-off level in diagnosing chronic pulmonary aspergillosis (CPA) remains unknown. Methods: We prospectively recruited participants with clinical suspicion of CPA in three centers in Taiwan during 2019 June to 2020 August. Serum <i>Aspergillus fumigatus</i>-specific IgG (<i>Asp</i>-IgG) (Phadia, Uppsala, UPPS, Sweden) was examined. Optimal cut-off level was determined by Youden’s index and validated. Results: A total of 373 participants were recruited. In the derivation cohort (<i>n</i> = 262), <i>Asp</i>-IgG had an area under the receiver-operating-characteristic curve (AUC) of 0.832. The optimal cut-off level was 40.5 mgA/L. While applying this cut-off level to the validation cohort (<i>n</i> = 111), the sensitivity and specificity were 86.7% and 80.2%. Lowering the cut-off level from 40.5 to 27 mgA/L, the sensitivity was steady (30/36, 83.3% to 31/36, 86.1%) while specificity dropped from 81.9% (276/337) to 63.5% (214/337). Restricting CPA diagnosis to only chronic cavitary pulmonary aspergillosis (CCPA) and chronic fibrosing pulmonary aspergillosis (CFPA) yielded a cut-off level of 42.3 mgA/L in the derivation cohort with a sensitivity of 100% and specificity of 84.4% in the validation cohort. Conclusions: Serum <i>Asp</i>-IgG performs well for CPA diagnosis and provides a low false-positive rate when using a higher cut-off level (preferably around 40 mgA/L).https://www.mdpi.com/2309-608X/7/6/480<i>Aspergillus fumigatus</i><i>Aspergillus</i> IgGchronic pulmonary aspergilluscut-off valueTaiwan |
| spellingShingle | Meng-Rui Lee Hung-Ling Huang Li-Ta Keng Hsu-Liang Chang Chau-Chyun Sheu Pin-Kuei Fu Jann-Yuan Wang Inn-Wen Chong Jin-Yuan Shih Chong-Jen Yu Establishing Aspergillus-Specific IgG Cut-Off Level for Chronic Pulmonary Aspergillosis Diagnosis: Multicenter Prospective Cohort Study Journal of Fungi <i>Aspergillus fumigatus</i> <i>Aspergillus</i> IgG chronic pulmonary aspergillus cut-off value Taiwan |
| title | Establishing Aspergillus-Specific IgG Cut-Off Level for Chronic Pulmonary Aspergillosis Diagnosis: Multicenter Prospective Cohort Study |
| title_full | Establishing Aspergillus-Specific IgG Cut-Off Level for Chronic Pulmonary Aspergillosis Diagnosis: Multicenter Prospective Cohort Study |
| title_fullStr | Establishing Aspergillus-Specific IgG Cut-Off Level for Chronic Pulmonary Aspergillosis Diagnosis: Multicenter Prospective Cohort Study |
| title_full_unstemmed | Establishing Aspergillus-Specific IgG Cut-Off Level for Chronic Pulmonary Aspergillosis Diagnosis: Multicenter Prospective Cohort Study |
| title_short | Establishing Aspergillus-Specific IgG Cut-Off Level for Chronic Pulmonary Aspergillosis Diagnosis: Multicenter Prospective Cohort Study |
| title_sort | establishing aspergillus specific igg cut off level for chronic pulmonary aspergillosis diagnosis multicenter prospective cohort study |
| topic | <i>Aspergillus fumigatus</i> <i>Aspergillus</i> IgG chronic pulmonary aspergillus cut-off value Taiwan |
| url | https://www.mdpi.com/2309-608X/7/6/480 |
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