Respiratory failure & ventilation
Interpretation of results of PCR and B-D-glucan for the diagnosis of Pneumocystis Jirovecii Pneumonia in immunocompromised adults with acute respiratory failure
Authors' conclusion
Although both tests yield a high intrinsic performance, the low incidence of PJP in this cohort resulted in a low positive post-test probability.
Study context
- Population
- Non-HIV immunocompromised adults with acute respiratory failure
- Participants
- 2,243 participants
- Comparison
- PCR vs Beta-D-Glucan (BDG) for diagnosis of PJP
- Outcome
- Post-test probability of PJP according to PCR and BDG results
Methodological detailsBayesian post-test probability simulation, diagnostic performance extracted from literature
- Bayesian post-test probability simulation
- Diagnostic performance extracted from literature
Performance
As reported in the abstract
Post-test probability of PJP, overall population
| Test or model | Positive post-test probability | Negative post-test probability |
|---|---|---|
| PCR | 32.9% (95%CI 31.1-34.8) | 0.10% (95%CI 0.09-0.11) |
| BDG | 22.8% (95%CI 21.5-24.3) | 0.23% (95%CI 0.21-0.25) |
Positive post-test probability
PCR32.9% (95%CI 31.1-34.8)
BDG22.8% (95%CI 21.5-24.3)
Negative post-test probability
PCR0.10% (95%CI 0.09-0.11)
BDG0.23% (95%CI 0.21-0.25)
- Incidence of PJP in non-HIV acute respiratory failure (ARF) patients
- 4.1% (95%CI 3.3-5)
Further findings
| Outcome | PCR | BDG |
|---|---|---|
| PPV in highest risk subgroup | ||
| PPV | 74.5% (95%CI 72.0-76.7) | 63.8% (95%CI 60.8-65.8) |
Incidence of PJP in 4 subgroups (supervised classification)
- Lowest: no ground glass opacities
- 2.0% (95%CI 1.4-2.8)
- Highest: hematopoietic cell transplantation, ground glass opacities and no PJP prophylaxis
- 20.2% (95%CI 14.1-27.7)
Original publication
Interpretation of results of PCR and B-D-glucan for the diagnosis of Pneumocystis Jirovecii Pneumonia in immunocompromised adults with acute respiratory failure. Ann Intensive Care. Published 31 July 2024. doi:10.
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