Soluble intercellular adhesion molecule (ICAM)-1 detects invasive fungal infections in patients following liver transplantation

Abstract

Purpose

Despite antifungal prophylaxis, liver transplanted patients are endangered by invasive fungal infections (IFI). Routinely used microbiological procedures are hallmarked by significant weaknesses, which may lead to a delay in antifungal treatment.

Methods

Culture-based fungal findings, routinely used biomarkers of infection/inflammation (e.g., procalcitonin or C-reactive protein), as well as corresponding plasma concentrations of soluble Intercellular Adhesion Molecule (ICAM)-1 were analysed in 93 patients during a period of 28 days following liver transplantation (LTX).

Results

Plasmatic sICAM-1 was significantly elevated in patients affected by an IFI within the first 28 days in comparison to fungally colonised or unobtrusive LTX patients. sICAM-1 might therefore be helpful for the identification of IFI patients after LTX (e.g., Receiver Operating Characteristic (ROC)-Area Under the Curve (AUC): 0.714 at 14d after LTX). The diagnostic performance of sICAM-1 was further improved by its combined use with different other IFI biomarkers (e.g., midregional proadrenomedullin).

Conclusion

The diagnostic deficiencies of routinely used microbiological procedures for IFI detection in patients after LTX may be reduced by plasmatic sICAM-1 measurements. Clinical Trial Notation. German Clinical Trials Register: DRKS00005480

Keywords:

• Candida spp.
• Aspergillus spp.
• soluble intercellular adhesion molecule-1
• invasive fungal infection
• liver transplantation
• fungal colonisation

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Raw data were collected at Heidelberg University Hospital. Derived data supporting the findings of this study are available from the corresponding author upon reasonable request.

Author contributions

SOD designed the primary study as well as the secondary analyses and wrote the manuscript. Moreover, he supported data acquisition and created the tables and figures. AI performed mass spectrometry measurements and revised the manuscript critically. HW was responsible for data acquisition and helped to revise the manuscript critically. FU, AH, AM, MM, KH and MAW were involved in the design of the primary study and the secondary analyses as well as in critical revision of the manuscript. TBru supported study design and performed all statistical analyses. Moreover, he revised the manuscript critically. SZ provided microbiological analyses and revised the manuscript critically. TBre supported the design of the primary study as well as the secondary analyses. Moreover, he coordinated manuscript drawing and revised it critically. All authors read and approved the final manuscript.

Additional information

Funding

This secondary analysis was carried out with financial resources of the Department of Anaesthesiology (Heidelberg University Hospital, Germany). Furthermore, the underlying primary study received a financial grant from Heidelberg Foundation of Surgery as well as B.Braun Foundation, Melsungen, Germany. Biomarker measurements were performed by Thermo Fisher Scientific (Henningsdorf, Germany).