Early Diagnostic Value Of Galactomannan Test In Bronchoalveolar Lavage Fluid For Invasive Pulmonary Aspergillosis With Non-neutropenic Patients

ObjectiveTo evaluate the early diagnostic value of the bronchoalveolar lavage fluid(BLAF)galactomannan(GM)test in invasive pulmonary aspergillosis(IPA)patients with non-granulocytosis.MethodsThe patients who were admitted to the Department of Respiratory Medicine of the First Affiliated Hospital of Nanchang University and suspected IPA from January2017 to December 2019 were collected for retrospective analysis.All patients were grouped according to the relevant research guidelines and diagnostic criteria of EORTC/MSG in 2008.Statistical analysis was performed on the clinical symptoms and radiological performance of patients in each group,and the receiver operating characteristic(ROC)curve was used to calculate the optimal cutoff value of the BALF GM test.In addition,according to the results of the BALF GM test,the non-IPA diagnostic components were divided into a positive group(case group)and a negative group(control group),and the risk factors of false positive results were analyzed.Result1.In the retrospective study,according to the inclusion and exclusion criteria,a total of 152 patients were included in the final study.64 patients were proven or probable IPA,20 patients were possible IPA,and 68 patients were non-IPA.2.There is a statistically significant difference in hemoptysis symptom between the IPA group and the non-IPA group(P =0.041).There is no significant statistical differences in the remaining symptoms and radiological signs.3.The ROC curve shows that the best cut-off value of the BALF GM test is 1.0,the sensitivity is 95.3%,the specificity is 72.1%,and the area under the curve is 0.896(95% CI 0.844-0.948).4.Univariate analysis result showed that Piperacillin/tazobactam could causefalse positives in the BALF GM test(P = 0.046),but Logistic regression analysis results did not help to find clinical risk factors clearly caused false positive results.ConclusionIn non-granulocytosis patients with IPA,the BALF GM test has certain early diagnostic value.The clinical symptoms and imaging signs of IPA lack specificity.According to the ROC curve,the best cut-off value of the BALF GM test is 1.0,and clinical attention should be paid to the identification of false positive results.