Table 3.

Advantages and disadvantages of invasive and non-invasive diagnostic tests for invasive candidiasis in liver disease and liver transplantation patients

Diagnostic tests	Advantages	Disadvantages
Non-invasive tests
(1,3)-β-d-glucan	• Useful for ruling out a diagnosis of IFI (high negative predictive value)142	• False positive common in ICU patients143 • False negative found for some Candida spp. such as C. parapsilosis81 • Limited sensitivity and poor positive predictive value in LTRs144
Galactomannan	• High negative prediction values for LD patients even for children145	• Limited clinical utility and false negative common in LTRs146 • Interference with piperacillin-tazobactam (false positive)146,147
Real-time PCR	• Highly specific and sensitive for suspected IC patients80 • Fastest among all diagnostic tests, allowing prompt definitive therapy for critically ill patients145	• No reference standard and approved validation148
Invasive tests
Blood culture	• Gold standard for IC75	• Long incubation time77 • Limited sensitivity for deep-seated candidiasis77,149 • C. glabrata takes longer time to positivity than C. albicans in IC patients150
Peritoneal fluid culture	• Gold standard for diagnosis of SFP151 • Good sensitivity, positive and negative predictive values for peritonitis observed in ICU patients with high risk factors152 • Associated with mortality in ICU patients153 • Easy to differentiate between SFP and peritonitis resulting from preexisting liver disease154	• Long turnover time for growth of Candida spp.3 • Difficult to distinguish true Candida spp. from contaminants155 • False negative due to culture techniques or prophylactic antifungal treatments156

Abbreviations: IC, invasive candidiasis; ICU, intensive care unit; IFI, invasive fungal infection; LD, liver disease; LTRs, liver transplant recipients; SFP, spontaneous fungal peritonitis.