诊断算法的性能在侵袭性肺阿斯伯吉洛症患者
Stefan Hatzl1,2, Christina Geiger3, Lisa Kriegl2,3
1Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
在ICU患者中,侵入性肺性阿斯伯吉洛症 (IPA) 诊断具有挑战性. 修改后的FUNDICU标准包括ARDS和心脏外科手术后改善了IPA的诊断准确性.
科学领域:
- 临界护理医学 临界护理医学
- 传染性疾病 传染性疾病
- 肺部病理学 肺部病理学
背景情况:
- 侵袭性肺阿斯伯吉洛症 (IPA) 越来越多地被认可为危急病重症监护室患者,往往缺乏传统风险因素.
- 由于获得组织学确认的挑战,IPA的准确诊断是很困难的.
- 目前对IPA的诊断算法在现实世界ICU设置中没有得到充分验证.
研究的目的:
- 评估现有的入侵性肺阿斯伯吉洛症 (IPA) 分类系统在重症患者队列中的表现.
- 评估修改后的标准对于改善重症监护室 (ICU) 患者的IPA诊断的有用性.
主要方法:
- 一项回顾性多中心队列研究,涉及202名IPA患者.
- 使用欧洲癌症/真菌病研究小组 (EORTC-MSG),在重症监护病房 (FUNDICU) 的成年患者的侵入性真菌病,阿斯伯吉勒斯-ICU (Asp-ICU) 和具有生物标志物的阿斯伯吉勒斯-ICU (Asp-ICU-BM) 标准的患者分类.
- 对临床和组织学证明的IPA病例进行诊断性能评估.
主要成果:
- 根据EORTC-MSG标准,对于患有EORTC-MSG宿主因子的患者,结果显示100%一致.
- 对于没有EORTC-MSG因子的ICU患者,FUNDICU的同意率为53%,Asp-ICU的同意率为4%,Asp-ICU-BM的同意率为26%.
- 修改后的FUNDICU标准,包括急性呼吸窘迫综合征 (ARDS) 和心脏手术后,显著提高了对97%的敏感性,具有63%的特异性.
结论:
- 现有的侵入性肺性阿斯伯吉洛症 (IPA) 分类系统,如EORTC-MSG和FUNDICU,对于患者分层非常有价值.
- 提高FUNDICU标准与ARDS和术后心脏手术并发症显著提高了ICU设置的诊断准确性.
- 对于缺乏EORTC-MSG宿主因子并且不在ICU的患者,可能需要一种新的分类系统.
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