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The Prognostic Value of (1→3)-β-D-Glucan in COVID-19 Patients with and Without Secondary Fungal Disease

Summary

During COVID-19, patients in intensive care sometimes develop dangerous fungal infections. Doctors use a blood test to measure a fungal marker called BDG to help diagnose these infections. This study found that even without confirmed fungal infection, high BDG levels predicted who would not survive, but giving antifungal medications improved survival even without proven infection.

Background

COVID-19 patients are at substantial risk for secondary invasive fungal disease (IFD) due to immunosuppressive medications and virus-related immune dysregulation. (1→3)-β-D-Glucan (BDG) is a polysaccharide found in pathogenic fungal cell walls and is used for early detection of IFD. Recent evidence suggests elevated BDG generates profound proinflammatory responses and is associated with poor prognosis regardless of IFD presence.

Objective

This study assessed the prognostic value of serum BDG in COVID-19-infected critical care patients with or without documented IFD and antifungal therapy (AFT). The research evaluated how BDG concentrations correlate with patient mortality considering the influences of IFD diagnosis and AFT administration.

Results

BDG concentration >31 pg/mL was associated with 91% mortality in patients without documented IFD and without AFT compared to 28% in those with BDG ≤31 pg/mL. Mortality dropped to 50% when AFT was administered despite elevated BDG. In patients with BDG >31 pg/mL without IFD or AFT, the average probability of death was 3.38-fold greater than baseline.

Conclusion

Elevated serum BDG serves as a prognostic marker in COVID-19-infected patients with or without IFD, likely due to associated proinflammatory responses. BDG concentration >31 pg/mL is associated with significant mortality in the absence of both documented IFD and antifungal therapy. When BDG is very low (≤31 pg/mL), mortality remains consistent with background COVID-19 ICU mortality rates.
  • Published in:Journal of Fungi,
  • Study Type:Retrospective Cohort Study,
  • Source: PMID: 41003202, DOI: 10.3390/jof11090656
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