Prognostic value of serial (1,3)-β-d-glucan measurements in ICU patients with invasive candidiasis

Abstract Background To determine whether a decrease in serum (1,3)-β-d-glucan (BDG) was associated with reduced mortality and to investigate the performance of BDG downslope in predicting clinical outcome in invasive candidiasis. Methods Observational cohort study in ICU patients over a ten-year period (2012–2022) in Italy. Proven invasive candidiasis with at least 2 BDG determinations were considered. Results In the study population of 103 patients (age 47 [35–62] years, SAPS II score 67 [52–77]) 68 bloodstream and 35 intrabdominal infections were recorded. Serial measurements showed that in 54 patients BDG decreased over time (BDG downslope group) while in 49 did not (N-BDG downslope group). Candida albicans was the pathogen most frequently isolated (61%) followed by C. parapsilosis (17%) and C. glabrata (12%), in absence of any inter-group difference. Invasive candidiasis related mortality was lower in BDG downslope than in N-BDG downslope group (17% vs 53%, p  70% predicted survival with both specificity and positive predictive value of 100%. Conclusions A decrease in serum BDG was associated with reduced mortality and a steep downslope predicted survival with high specificity in invasive candidiasis.