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Zeyda M, Schanzer A, Basek P, Bauer V, Eber E, Ellemunter H, Kallinger M, Riedler J, Thir C, Wadlegger F, Zacharasiewicz A, Renner S. Cystic Fibrosis Newborn Screening in Austria Using PAP and the Numeric Product of PAP and IRT Concentrations as Second-Tier Parameters. Diagnostics (Basel) 2021; 11:diagnostics11020299. [PMID: 33668470 PMCID: PMC7918494 DOI: 10.3390/diagnostics11020299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/21/2022] Open
Abstract
In Austria, newborns have been screened for cystic fibrosis (CF) by analyzing immunoreactive trypsinogen (IRT) from dried blood spots (DBS)s for nearly 20 years. Recently, pancreatitis-associated protein (PAP) analysis was introduced as a second-tier test with the aim of reducing recalls for second DBS cards while keeping sensitivity high. For 28 months, when IRT was elevated (65–130 ng/mL), PAP was measured from the first DBS (n = 198,927) with a two-step cut-off applied. For the last 12 months of the observation period (n = 85,421), an additional IRT×PAP cut-off was introduced. If PAP or IRT×PAP were above cut-off, a second card was analyzed for IRT and in case of elevated values identified as screen-positive. Above 130 ng/mL IRT in the first DBS, newborns were classified as screen-positive. IRT analysis of first DBS resulted in 1961 (1%) tests for PAP. In the first 16 months, 26 of 93 screen-positive were confirmed to have CF. Two false-negatives have been reported (sensitivity = 92.8%). Importantly, less than 30% of families compared to the previous IRT-IRT screening scheme had to be contacted causing distress. Adding IRT×PAP caused a marginally increased number of second cards and sweat tests to be requested during this period (15 and 3, respectively) compared to the initial IRT-PAP scheme. One case of confirmed CF was found due to IRT×PAP, demonstrating an increase in sensitivity. Thus, the relatively simple and economical algorithm presented here performs effectively and may be a useful model for inclusion of CF into NBS panels or modification of existing schemes.
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Affiliation(s)
- Maximilian Zeyda
- Clinical Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.S.); (S.R.)
- Correspondence:
| | - Andrea Schanzer
- Clinical Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.S.); (S.R.)
| | - Pavel Basek
- University Clinic for Paediatric and Adolescent Medicine, University Hospital Salzburg, 5020 Salzburg, Austria;
| | - Vera Bauer
- Department of Pediatrics and Adolescent Medicine, Klinikum Wels-Grieskirchen, 4600 Wels, Austria;
| | - Ernst Eber
- Division of Pediatric Pulmonology and Allergology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria;
| | - Helmut Ellemunter
- Department of Child and Adolescent Health, Division of Cardiology, Pulmonology, Allergology, and Cystic Fibrosis, Cystic Fibrosis Centre, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Margit Kallinger
- PEK Hospital Steyr Department of Pediatrics and Adolescent Medicine, 4400 Steyr, Austria;
| | - Josef Riedler
- Department of Pediatrics and Adolescent Medicine, Kardinal Schwarzenberg Hospital Schwarzach, 5620 Schwarzach, Austria;
| | - Christina Thir
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, 4040 Linz, Austria;
| | - Franz Wadlegger
- Division of Pediatric Pulmonology and Allergology, Department of Pediatrics and Adolescent Medicine, Hopital Klagenfurt am Wörthersee, 9020 Klagenfurt am Wörthersee, Austria;
| | - Angela Zacharasiewicz
- Department of Pediatrics and Adolescent Medicine, Klinikum Ottakring, Wilhelminenspital, Teaching Hospital of the University of Vienna, 1010 Vienna, Austria;
| | - Sabine Renner
- Clinical Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.S.); (S.R.)
- Associated National Center in the European Reference Network for Rare Respiratory Diseases, ERN-LUNG Coordinating Center, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
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Managing Cystic Fibrosis in Polish Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207630. [PMID: 33092012 PMCID: PMC7589707 DOI: 10.3390/ijerph17207630] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 12/11/2022]
Abstract
The quality and length of life of patients with cystic fibrosis (CF) are determined by a number of factors including the quality of healthcare received by patients, as well as access to drug programs dedicated to this particular disease. The purpose of this paper is to present an overview of changes in the average life expectancy and mortality rate of the CF population in Poland between 2000 and 2018. Furthermore, we would like to evaluate access to healthcare services, including the drug program, guaranteed by public healthcare system, and funded by National Health Fund (NHF). The average life expectancy of patients with CF increased in the period in question from ca. 14.5 ± 7.6–24.5 ± 8.9 years (mean ± SD, p = 0.0001). We have observed a drop in the number of deaths in paediatric age during that period. Despite the increase in life expectancy, the use of health resources in patients with CF, especially the drug program, is dramatically low. Considering the fact that in Poland there was no active countrywide CF registry, now it is possible to estimate the frequency of use of CF healthcare services in various provinces exclusively on the basis of database maintained by the Polish NHF.
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