# Lateral Flow Device Aspergillus Routine Testing for Invasive Pulmonary Aspergillosis in Patients Who Are Critically Ill: A Multicenter Intensive Care Unit Cohort Study

## TL;DR

A new rapid test for a dangerous lung infection in ICU patients shows high accuracy and could help doctors act faster.

## Contribution

The study evaluates a lateral flow device for rapid Aspergillus detection in ICU patients, showing strong clinical utility.

## Key findings

- The lateral flow device test showed 71% sensitivity and 98% specificity for diagnosing probable IPA.
- The test has a high positive predictive value (92%) and negative predictive value (90%).
- The diagnostic odds ratio was 104, indicating strong diagnostic performance.

## Abstract

The incidence of invasive pulmonary aspergillosis (IPA) is rising among intensive care unit (ICU) patients, with early diagnosis and treatment being critical for survival. Lateral flow assays for Aspergillus antigen detection have recently been introduced, enabling rapid results within an hour and potentially supporting earlier clinical decision making and timely antifungal therapy.

This retrospective multicenter study included 180 ICU patients, 48 with IPA and 132 controls, across 9 treatment centers. Fungal infections were classified according to the FUNDICU criteria (Invasive Fungal Diseases in Adult Patients in Intensive Care Unit).

Among the 180 patients, 48 were classified as having probable IPA, while 132 exhibited host factors and radiologic findings consistent with IPA but did not meet the FUNDICU criteria. In this cohort, the sensitivity and specificity of the bronchoalveolar lavage lateral flow device test for diagnosing probable IPA vs no IPA were 71% (95% CI, 56%–83%) and 98% (94%–100%), respectively. The area under the receiver operating characteristic curve was 0.84, indicating good diagnostic performance. The positive and negative likelihood ratios were 31.17 (10.03–96.80) and 0.30 (.19–.46), yielding a diagnostic odds ratio of 104 (30–360). The positive and negative predictive values were 92% (78%–98%) and 90% (84%–95%).

Lateral flow device testing may serve as a valuable tool for the rapid diagnosis of IPA in time-critical ICU settings. However, it is not sufficient to definitively rule out the disease, and a comprehensive diagnostic approach remains essential.

Graphical AbstractThis diagram summarizes a retrospective multicenter observational study conducted from January 2019 to January 2025, including 9 treatment centers. The study focused on the use of bedside Aspergillus LFD testing for IPA in the intensive care unit (ICU). The study included 180 ICU patients at risk for IPA per the recent FUNDICU algorithm. Results showed that the Aspergillus LFD test had a specificity of 98%, sensitivity of 71%, positive predictive value (PPV) of 92%, and negative predictive value (NPV) of 90%. The study concluded that the Aspergillus LFD test is a valuable, easy-to-use, and rapid diagnostic tool for detecting IPA in ICU patients.

This diagram summarizes a retrospective multicenter observational study conducted from January 2019 to January 2025, including 9 treatment centers. The study focused on the use of bedside Aspergillus LFD testing for IPA in the intensive care unit (ICU). The study included 180 ICU patients at risk for IPA per the recent FUNDICU algorithm. Results showed that the Aspergillus LFD test had a specificity of 98%, sensitivity of 71%, positive predictive value (PPV) of 92%, and negative predictive value (NPV) of 90%. The study concluded that the Aspergillus LFD test is a valuable, easy-to-use, and rapid diagnostic tool for detecting IPA in ICU patients.

This multicenter study evaluated a bedside lateral flow device test for invasive pulmonary aspergillosis in 180 patients in the intensive care unit (48 cases, 132 controls). The test demonstrated 71% sensitivity and 98% specificity, showing good diagnostic accuracy and practical use in real-world settings.