Abstract: 【Abstract】Aim To evaluate the clinical application value of 1- 3- β-D glucan (BG) and galactomannan (GM) detection in the early diagnosis of peritoneal dialysis-related fungal peritonitis. Method The continuous ambulatory peritoneal dialysis (CAPD) patients diagnosed with peritonitis during January 2008 to January 2019 were retrospectively analyzed. In these patients, detections of serum BG and GM were performed in 63 cases. Fungi were detected in ascites in 22 cases; bacteria were found in ascites in 41 cases; we also enrolled 11 cases as the controls. In the 74 cases we analyzed in this study, 38 cases were males and 36 cases were females, with the average age of 50.65±13.31 years and the average dialysis age of 37.08±25.01 months. When the results of serum BG and/or GM tests greater than the borderline values, combined therapy containing fluconazole or voriconazole was issued immediately. The period between admission and initiation of antifungal therapy, hospitalized day, and survival rate within 90 days were recorded. The diagnostic value for fungal peritonitis using BG test, GM test and combined BG and GM tests was assessed by a 4-cell scale method. Results The diagnostic sensitivity, specificity, positive predictive value and negative predictive value for fungal peritonitis were 86.4%, 95.1%, 90.5% and 92.9% respectively by BG test, and were 36.4%, 92.7%, 72.7% and
73.1% respectively by GM test. The diagnostic sensitivity and specificity for fungal peritonitis were 95.5% and 97.6% respectively by combined BG and GM tests. The period between admission and initiation of antifungal therapy was shorter in patients undergoing combined BG and GM tests than in the control cases (15.71± 5.65h vs. 50.18±9.99h, P=0.000); the average hospitalized day was also shorter in patients undergoing combined BG and GM tests than in the control cases (15.64±3.55 days vs. 21.00±4.75 days, P=0.001); the survival rate within 90 days was higher in patients undergoing combined BG and GM tests than in the control cases (95.45% vs. 63.64%; c2=5.515, P=0.019). Conclusion Simultaneous BG and GM tests provide a powerful tool for the early diagnosis of fungal peritonitis with higher sensitivity and specificity, from which antifungal medications can be given earlier, and better prognosis and lower mortality rate can be obtained in patients with PD-related fungal peritonitis.

Key words: 1-3-β-D glucan, Galactomannan, Peritoneal dialysis, Fungal peritonitis