Serum Lateral Flow Assay with Digital Reader for the Diagnosis of Invasive Pulmonary Aspergillosis: A Two Center Mixed Cohort Study
Mycoses. 2021 Jul 12. doi: 10.1111/myc.13352. Online ahead of print.
BACKGROUND: Detection of galactomannan (GM) from bronchoalveolar lavage fluid (BALF) or serum is broadly used for diagnosis of invasive aspergillosis (IA), although the sensitivity of GM from serum is lower in non-neutropenic patients. We evaluated the Aspergillus galactomannan lateral flow assay (LFA) with digital readout from serum in a mixed cohort of patients.
METHODS: We performed a retrospective two-center study evaluating the LFA from serum of patients with clinical suspicion of IA obtained between 2015 and 2021 at the University of California San Diego (UCSD) and the Medical University of Graz. The sensitivity and specificity was calculated for proven/probable aspergillosis versus no aspergillosis. Correlation with same-sample GM was calculated using Spearman correlation analysis and kappa statistics.
RESULTS: In total, 122 serum samples from 122 patients were analyzed, including proven IA (n=1), probable IA or coronavirus-associated pulmonary aspergillosis (CAPA) (n=27), and no IA/CAPA/non-classifiable (n=94). At a 0.5 ODI cutoff, the sensitivity and specificity of the LFA was 78.6% and 80.5%. Spearman correlation analysis showed a strong correlation between serum LFA ODI and serum GM ODI (rho 0.459, p<0.0001). Kappa was 0.611 when both LFA and GM were used with a 0.5 ODI cutoff, showing substantial agreement (p<0.001).
DISCUSSION: The LFA with digital read out from serum showed good performance for the diagnosis of probable/proven aspergillosis, with substantial agreement to GM from serum. Like the LFA from BALF, the LFA from serum may serve as a more rapid test compared to conventional GM, particularly in settings where GM is not readily available.