Lipopolysaccharide Binding Protein and Bactericidal/Permeability-Increasing Protein as Biomarkers for Invasive Pulmonary Aspergillosis
2020
Sigrid Bülow | Robert Heyd | Martina Toelge | Katharina U. Ederer | Annette Schweda | Stefan H. Blaas | Okka W. Hamer | Andreas Hiergeist | Jürgen J. Wenzel | André Gessner
Early diagnosis of invasive pulmonary aspergillosis (IPA) is crucial to prevent lethal disease in immunocompromized hosts. So far, lipopolysaccharide binding protein (LBP) and bactericidal/permeability-increasing protein (BPI) levels have not been evaluated as biomarkers for IPA. IL-8, previously introduced as a biomarker for IPA, was also included in this study. Bronchoalveolar lavage fluid (BALF) of IPA patients and control patients with non-infectious lung disease was collected according to clinical indications. Measurements in BALF displayed significantly higher levels of LBP (p <: 0.0001), BPI (p = 0.0002) and IL-8 (p <: 0.0001) in IPA compared to control patients. Receiver operating characteristic curve analysis revealed higher AUC for LBP (0.98, 95% CI 0.95&ndash:1.00) than BPI (0.84, 95% CI 0.70&ndash:0.97: p = 0.0301). Although not significantly different, AUC of IL-8 (0.93, 95% CI 0.85&ndash:1.00) also tended to be higher than AUC for BPI (p = 0.0624). When the subgroup of non-hematological patients was analyzed, test performance of LBP (AUC 0.99, 95% CI 0.97&ndash:1.00), BPI (AUC 0.97, 95% CI 0.91&ndash:1.00) and IL-8 (AUC 0.96, 95% CI: 0.90&ndash:1.00) converged. In conclusion, LBP and&mdash:to a lesser extend&mdash:BPI displayed high AUCs that were comparable to those of IL-8 for diagnosis of IPA in BALF. Further investigations are worthwhile, especially in non-hematological patients in whom sensitive biomarkers for IPA are lacking.
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