Pentraxin 3 levels in bronchoalveolar lavage fluid of lung transplant recipients with invasive aspergillosis

J Heart Lung Transplant. 2017 Sep;36(9):973-979. doi: 10.1016/j.healun.2017.04.007. Epub 2017 Apr 19.

Abstract

Background: Invasive aspergillosis is the most common invasive fungal infection in lung transplant recipients. The use of galactomannan testing in bronchoalveolar lavage (BAL) fluid has improved diagnosis of invasive aspergillosis; however, false-positive results can lead to overdiagnosis and unnecessary treatment. The use of proinflammatory markers such as pentraxin 3 (PTX3) may help differentiate between Aspergillus colonization and disease.

Methods: BAL PTX3 concentrations were measured by enzyme-linked immunosorbent assay in 151 lung transplant recipients and 9 healthy control subjects. Patients were characterized as having Aspergillus colonization or invasive disease according to International Society of Heart and Lung Transplantation criteria. Concomitant PTX3values were compared using Mann-Whitney U and Kruskal-Wallis tests.

Results: We analyzed 322 BAL stored samples and identified 15 invasive aspergillosis events, 38 Aspergillus colonizations, and 17 positive galactomannan with negative Aspergillus cultures. Median BAL PTX3 level was significantly higher in patients with invasive aspergillosis compared with patients with Aspergillus colonization and healthy control subjects (439.20 pg/ml [interquartile range (IQR) 168.18-778.90], 68.93 pg/ml [IQR 13.67-156.74], and 13.67 pg/ml [IQR 13.67-121.18]; p < 0.001). Patients with BAL PTX3 value >319 pg/ml with positive galactomannan and patients with BAL PTX3 value >312 pg/ml with positive Aspergillus culture were 4.5 and 5.5 times more likely to have invasive pulmonary aspergillosis, respectively.

Conclusions: Our study shows that PTX3 measurements in BAL samples were significantly higher among patients with invasive aspergillosis and may help to identify patients with Aspergillus colonization and false-positive galactomannan in BAL samples.

Keywords: BAL PTX3; BAL galactomannan; inflammatory marker; invasive aspergillosis; lung transplantation.

MeSH terms

  • Adult
  • Biomarkers / analysis
  • Bronchoalveolar Lavage Fluid / microbiology*
  • C-Reactive Protein / analysis
  • C-Reactive Protein / metabolism*
  • Case-Control Studies
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Graft Survival
  • Humans
  • Invasive Pulmonary Aspergillosis / diagnosis*
  • Invasive Pulmonary Aspergillosis / mortality
  • Lung Transplantation / adverse effects*
  • Lung Transplantation / methods
  • Male
  • Middle Aged
  • Postoperative Complications / diagnosis
  • Prognosis
  • Reference Values
  • Retrospective Studies
  • Risk Assessment
  • Serum Amyloid P-Component / analysis
  • Serum Amyloid P-Component / metabolism*
  • Survival Rate
  • Transplant Recipients

Substances

  • Biomarkers
  • Serum Amyloid P-Component
  • PTX3 protein
  • C-Reactive Protein