The influence of continuous renal replacement therapy on 1,3-β-d-glucan levels in critically ill patients: a single-center retrospective propensity score study
M. Gabriela Cabanilla,
Matthew J. Briski,
Zachary Bruss,
Lisa Saa,
Pamela C. Vasquez,
Chelsea N. Rodriguez,
Jessica A. Mitchell,
Michael L. Bernauer,
Christos P. Argyropoulos,
Cameron S. Crandall,
J. Pedro Teixeira
Affiliations
M. Gabriela Cabanilla
Department of Internal Medicine and Department of Pharmacy, Division of Infectious Diseases, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
Matthew J. Briski
Department of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
Zachary Bruss
Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
Lisa Saa
Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
Pamela C. Vasquez
Department of Internal Medicine, Division of Nephrology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
Chelsea N. Rodriguez
Department of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
Jessica A. Mitchell
Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
Michael L. Bernauer
Data Science, RS21, Albuquerque, NM, USA
Christos P. Argyropoulos
Department of Internal Medicine, Division of Nephrology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
Cameron S. Crandall
Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
J. Pedro Teixeira
Department of Internal Medicine, Division of Nephrology, Division of Pulmonary, Critical Care and Sleep Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
1,3-β-d-Glucan (BDG) is commonly used for diagnosing invasive fungal infections (IFIs). While exposure to cellulose-based hemodialyzers is known to cause false-positive BDG results, the impact of modern hemofilters used in continuous renal replacement therapy (CRRT) remains unclear. This retrospective, single-center cohort study aimed to evaluate the effect of CRRT on BDG levels in critically ill patients. We included adult intensive care unit (ICU) patients with ≥1 BDG measurement between December 2019 and December 2020. The primary outcome was the rate of false-positive BDG results in patients exposed to CRRT compared to unexposed patients. Propensity score analysis was performed to control for confounding factors. A total of 103 ICU patients with ≥1 BDG level were identified. Most (72.8%) were medical ICU patients. Forty patients underwent CRRT using hemofilter membranes composed of sodium methallyl sulfonate copolymer (AN 69 HF) (82.5%) and of polyarylethersulfone (PAES) (17.5%). Among the 91 patients without proven IFI, 31 (34.1%) had false-positive BDG results. Univariable analysis showed an association between CRRT exposure and false-positive BDG results. However, the association between CRRT exposure and false-positive BDG results was no longer significant across three propensity score models employed: 1:1 match (n = 32) (odds ratio (OR) 1.65, p = .48), model-adjusted (n = 91) (OR 1.75, p = .38), quintile-adjusted (n = 91) (OR 1.78, p = .36). In this single-center retrospective analysis, exposure to synthetic CRRT membranes did not independently increase the risk of false-positive BDG results. Larger prospective studies are needed to further evaluate the association between CRRT exposure and false-positive BDG results in critically ill patients with suspected IFI.
