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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 infection, a fungal marker called beta-D-glucan (BDG) in the blood can predict patient survival even without a diagnosed fungal infection. Researchers found that COVID-19 patients with high BDG levels had a 91% death rate if not treated with antifungal drugs, but this dropped to 50% when antifungal therapy was given. The high BDG levels trigger a strong inflammatory response in the body that worsens disease severity, making BDG a valuable warning sign for doctors treating critically ill COVID-19 patients.

Background

COVID-19 infection is complicated by secondary invasive fungal disease (IFD) in a significant proportion of patients, particularly those requiring critical care. (1→3)-β-D-Glucan (BDG) is a fungal cell wall component used for IFD diagnosis but emerging evidence suggests elevated BDG may predict mortality independent of documented fungal infection through pro-inflammatory mechanisms.

Objective

To assess the prognostic value of serum BDG concentration in COVID-19-infected critical care patients, evaluating mortality associations with or without documented IFD and antifungal therapy (AFT).

Results

BDG concentration >31 pg/mL was associated with 91% mortality in patients without documented IFD and without AFT versus 28% with BDG ≤31 pg/mL. AFT reduced mortality to 50% in BDG-positive patients without IFD. Multivariable analysis showed BDG >31 pg/mL without IFD or AFT increased mortality probability 3.38-fold, with odds ratio of 25.79.

Conclusion

Elevated serum BDG serves as a significant prognostic marker in COVID-19 patients, associated with substantial mortality even without documented IFD. The pro-inflammatory immune response to BDG likely contributes to poor outcomes. Patients with BDG ≤31 pg/mL have mortality consistent with background COVID-19 ICU rates, while BDG >31 pg/mL warrants consideration of antifungal therapy.
  • Published in:Journal of Fungi (Basel),
  • Study Type:Retrospective Cohort Study,
  • Source: PMID: 41003202, DOI: 10.3390/jof11090656
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