Validation of serum galactomannan antigen assay for invasive pulmonary aspergillosis mortality outcome prediction

Serum galactomannan enzyme immunoassay (sGMI) is a well-established, non-invasive diagnostic tool for invasive aspergillosis and has been incorporated into numerous clinical guidelines. Despite its diagnostic utility, the prognostic value of sGMI in IA patients was not well validated due to limitations in previous studies, including small sample sizes and methodological issues. This study systematically reviewed and validated existing sGMI prognostic markers in a large Taiwanese invasive pulmonary aspergillosis cohort. A sGMI ≥2 at baseline and a day 7 sGMI ≥1.5 were significant predictors for 30-day, 90-day, and in-hospital mortality. We propose that these markers can be used at different stages of IPA treatment to predict patient outcomes. Our research is the first to validate both static and kinetic sGMI markers in a large IPA cohort. The simplicity and practicality of using a baseline sGMI ≥2 at diagnosis for mortality prediction offer significant advantages and support medical decisions.