Table 1.
Anticipated Positive and Negative Predictive Values of CAPA Diagnostic Criteria for Invasive Aspergillosis
| CAPA Likelihood | BAL GM Cutoff 0.5 (Sens/Spec: 85%/80%)a |
BAL GM Cutoff 1.0 (Sens/Spec: 75%/90%)a |
BAL GM Cutoff 1.0 (Sens/Spec: 80%/94%)a |
||||||
|---|---|---|---|---|---|---|---|---|---|
| PPV for IPA | NPV for IPA | IPA Incidence | PPV for IPA | NPV for IPA | IPA Incidence | PPV for IPA | NPV for IPA | IPA Incidence | |
| 1% | 4% | >99% | <0.1% | 7% | >99% | <0.1% | 12% | >99% | <0.1% |
| 2% | 8% | >99% | 0.1% | 13% | >99% | 0.2% | 21% | >99% | 0.3% |
| 3% | 12% | >99% | 0.5% | 19% | >99% | 0.5% | 32% | >99% | 1% |
| 5% | 22% | 99% | 1% | 28% | 99% | 1% | 40% | 99% | 2% |
| 10% | 32% | 98% | 3% | 45% | 97% | 3% | 60% | 98% | 5% |
| 15% | 43% | 97% | 6% | 57% | 95% | 6% | 71% | 96% | 9% |
| 20% | 52% | 96% | 9% | 65% | 94% | 10% | 76% | 95% | 12% |
Abbreviations: BAL, bronchoalveolar lavage; CAPA, coronavirus disease 2019-associated pulmonary aspergillosis; GM, galactomannan; PPV, positive predictive value; NPV, negative predictive value; Sens, sensitivity; Spec, specificity.
CAPA has been diagnosed in 0% to 33% of critically ill COVID-19 patients in intensive care units (ICUs) at different hospitals. Optimal BAL galactomannan cutoffs for diagnosing invasive aspergillosis in patients with COVID-19 are not defined [7, 11]. Cutoffs and test performance in non-COVID-19 populations can be used to estimate positive predictive values (PPVs) and negative predictive values (NPVs) for invasive aspergillosis in ICUs with various underlying burdens of CAPA (column 1). Bolded text shows PPVs > 15% and NPVs ≥94%, representing settings in which CAPA criteria might be useful in guiding treatment decisions. PPVs ≥15%–30% may be sufficiently high to justify empiric antifungal treatment, depending on constellation of clinical findings and other data in individual patients (Table 3). NPVs are likely high enough to justify withholding antifungal treatment. Clinicians can modify calculations based on local epidemiology and knowledge of test performance.