Vol.74 No.2 March 2026
Association of elevated serum (1→3)-β-D-glucan levels with invasive fungal infections/mortality in patients admitted to the intensive care unit
1)Department of Oncology and Infectious Disease Pharmacy, Faculty of Pharmaceutical Sciences, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka, Japan
2)Department of Emergency and Critical Care Medicine, Fukuoka University Hospital
Abstract
(1→3)-β-D-glucan (BDG) serves as a supplementary diagnostic marker for invasive fungal infections (IFI), and high serum BDG levels are also known to be correlated with an increased risk of mortality in patients with IFI. However, studies on the clinical/prognostic significance of high serum BDG levels are limited. This retrospective cohort study using propensity score analysis was aimed at evaluating the impact of high serum BDG levels on the mortality in patients admitted to the intensive care unit (ICU).
Patients admitted to the ICU at Fukuoka University Hospital between January 2016 and June 2024 who tested positive for serum BDG by the β-Glucan Test® were included in this study and were categorized into two groups; those with serum BDG levels of 11-55 pg/mL (group<5x, n=207) and those with serum BDG levels of ≥55 pg/mL (group≥5x, n=59). After performing 2:1 propensity score matching, we compared the 30-day mortality rate, incidence of IFI, and survival duration between the two groups. In addition, we also analyzed the risk factors for mortality.
Before and after the matching, the 30-day mortality rates in the two groups were 20.8% vs. 23.7% and 29.5% vs. 25.0%, respectively, with no significant intergroup differences. The incidence of proven or probable IFI was 2.4% vs. 17.0% before the matching and 2.3% vs. 15.9% after the matching, being significantly higher in group≥5x both before and after matching. Kaplan-Meier survival analysis showed no significant difference in survival between the two groups (p=0.93). Multivariate analysis using a Cox proportional hazards model identified the Acute Physiologic Assessment and Chronic Health Evaluation II score, Pitt bacteremia score, and renal replacement therapy, but not the serum BDG level, as independent risk factors for 30-day mortality.
ICU patients often showed false-positive results for serum BDG, and high levels were not associated with increased mortality. However, high serum BDG levels were significantly associated with a higher incidence of IFI. Active investigation for IFI and early initiation of antifungal therapy may help improve the outcomes in these patients.
Key word
（1→3）-β-D-glucan, intensive care unit, invasive fungal infection
Received
July 25, 2025
Accepted
November 18, 2025
Jpn. J. Chemother. 74 (2): 142-152, 2026
