ArticlePloS one2013
Performance of serum biomarkers for the early detection of invasive aspergillosis in febrile, neutropenic patients: a multi-state model.
Article in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 5 of them syntheses that pooled it.
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Who cites it
15 citing papers in PubMed, 5 syntheses or guidelines pooled it, 36 citations in OpenAlex.
- [Chinese guidelines for the clinical application of antibacterial drugs for febrile neutropenia (2026)].Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi · 2026Guideline
- Age difference of patients with and without invasive aspergillosis: a systematic review and meta-analysis.BMC infectious diseases · 2024Pooled it
- Polymerase chain reaction blood tests for the diagnosis of invasive aspergillosis in immunocompromised people.The Cochrane database of systematic reviews · 2019Pooled it
- Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Guideline
- PCR in diagnosis of invasive aspergillosis: a meta-analysis of diagnostic performance.Journal of clinical microbiology · 2014Pooled it
- Non-invasive diagnosis of invasive fungal disease with cell-free DNA PCR.Journal of clinical microbiology · 2026Review
- Amphotericin B ResistantInfectious diseases & clinical microbiology · 2024Article
- Article
- Utility of serum galactomannan antigen testing combined with chest computed tomography for early diagnosis of invasive pulmonary aspergillosis in patients with hematological malignancies with febrile neutropenia after antifungal drug treatment.The Journal of international medical research · 2019Article
- Predicting Invasive Aspergillosis in Hematology Patients by Combining Clinical and Genetic Risk Factors with Early Diagnostic Biomarkers.Journal of clinical microbiology · 2018Article
- CirculatingFrontiers in microbiology · 2017Article
- Challenges in microbiological diagnosis of invasiveF1000Research · 2017Review
- Use of Fungal Diagnostics and Therapy in Pediatric Cancer Patients in Resource-Limited Settings.Current clinical microbiology reports · 2016Article
- Prospective Evaluation of Serum β-Glucan Testing in Patients With Probable or Proven Fungal Diseases.Open forum infectious diseases · 2016Article
- Diagnostic-driven antifungal therapy in neutropenic patients using the D-index and serial serum galactomannan testing.The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious DiseasesArticle
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe performance of serum biomarkers for the early detection of invasive aspergillosis expectedly depends on the timing of test results relative to the empirical administration of antifungal therapy during neutropenia, although a dynamic evaluation framework is lacking.
methodsWe developed a multi-state model describing simultaneously the likelihood of empirical antifungal therapy and the risk of invasive aspergillosis during neutropenia. We evaluated whether the first positive test result with a biomarker is an independent predictor of invasive aspergillosis when both diagnostic information used to treat and risk factors of developing invasive aspergillosis are taken into account over time. We applied the multi-state model to a homogeneous cohort of 185 high-risk patients with acute myeloid leukemia. Patients were prospectively screened for galactomannan antigenemia twice a week for immediate treatment decision; 2,214 serum samples were collected on the same days and blindly assessed for (1->3)- β-D-glucan antigenemia and a quantitative PCR assay targeting a mitochondrial locus.
resultsThe usual evaluation framework of biomarker performance was unable to distinguish clinical benefits of β-glucan or PCR assays. The multi-state model evidenced that the risk of invasive aspergillosis is a complex time function of neutropenia duration and risk management. The quantitative PCR assay accelerated the early detection of invasive aspergillosis (P = .010), independently of other diagnostic information used to treat, while β-glucan assay did not (P = .53).
conclusionsThe performance of serum biomarkers for the early detection of invasive aspergillosis is better apprehended by the evaluation of time-varying predictors in a multi-state model. Our results provide strong rationale for prospective studies testing a preemptive antifungal therapy, guided by clinical, radiological, and bi-weekly blood screening with galactomannan antigenemia and a standardized quantitative PCR assay.
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