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Pócsi M, Fejes Z, Bene Z, Nagy A, Balogh I, Amaral MD, Macek M, Nagy B. Human epididymis protein 4 (HE4) plasma concentration inversely correlates with the improvement of cystic fibrosis lung disease in p.Phe508del-CFTR homozygous cases treated with the CFTR modulator lumacaftor/ivacaftor combination. J Cyst Fibros 2023; 22:1085-1092. [PMID: 37087300 DOI: 10.1016/j.jcf.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND We previously documented that elevated HE4 plasma concentration decreased in people with CF (pwCF) bearing the p.Gly551Asp-CFTR variant in response to CFTR modulator (CFTRm) ivacaftor (IVA), and this level was inversely correlated with the FEV1% predicted values (ppFEV1). Although the effectiveness of lumacaftor (LUM)/IVA in pwCF homozygous for the p.Phe508del-CFTR variant has been evaluated, plasma biomarkers were not used to monitor treatment efficacy thus far. METHODS Plasma HE4 concentration was examined in 68 pwCF drawn from the PROSPECT study who were homozygous for the p.Phe508del-CFTR variant before treatment and at 1, 3, 6 and 12 months after administration of LUM/IVA therapy. Plasma HE4 was correlated with ppFEV1 using their absolute and delta values. The discriminatory power of delta HE4 was evaluated for the detection of lung function improvements based on ROC-AUC analysis and multiple regression test. RESULTS HE4 plasma concentration was significantly reduced below baseline following LUM/IVA administration during the entire study period. The mean change of ppFEV1 was 2.6% (95% CI, 0.6 to 4.5) by 6 months of therapy in this sub-cohort. A significant inverse correlation between delta values of HE4 and ppFEV1 was observed especially in children with CF (r=-0.7053; p<0.0001). Delta HE4 predicted a 2.6% mean change in ppFEV1 (AUC: 0.7898 [95% CI 0.6823-0.8972]; P < 0.0001) at a cut-off value of -10.7 pmol/L. Moreover, delta HE4 independently represented the likelihood of being a responder with ≥ 5% delta ppFEV1 at 6 months (OR: 0.89, 95% CI: 0.82-0.95; P = 0.001). CONCLUSIONS Plasma HE4 level negatively correlates with lung function improvement assessed by ppFEV1 in pwCF undergoing LUM/IVA CFTRm treatment.
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Affiliation(s)
- Marianna Pócsi
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Laki Kálmán Doctoral School, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsolt Fejes
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsolt Bene
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Attila Nagy
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - István Balogh
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Division of Clinical Genetics, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Margarida D Amaral
- BioISI - Biosystems & Integrative Sciences Institute, Faculty of Sciences, University of Lisboa, Lisboa, Portugal
| | - Milan Macek
- Department of Biology and Medical Genetics, 2nd Faculty of Medicine of Charles University and Motol University Hospital, Prague, Czech Republic
| | - Béla Nagy
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
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Bedran RM, Alvim CG, Sader OG, Alves Júnior JV, Pereira FH, Nolasco DM, Zhang L, Camargos P. Sweat conductivity for diagnosing cystic fibrosis after positive newborn screening: prospective, diagnostic test accuracy study. Arch Dis Child 2023:archdischild-2022-324723. [PMID: 36914231 DOI: 10.1136/archdischild-2022-324723] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/22/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To assess the accuracy of sweat conductivity among newborns and very young infants. DESIGN Prospective, population-based, diagnostic test accuracy study. SETTING Public Statewide Newborn Screening Programme where the incidence rate of cystic fibrosis (CF) is ≈1:11 000. PATIENTS Newborns and very young infants with positive two-tiered immunoreactive trypsinogen. INTERVENTIONS Sweat conductivity and sweat chloride were performed simultaneously, on the same day and facility by independent technicians, with the cut-off values of 80 mmol/L and 60 mmol/L, respectively. MAIN OUTCOME MEASURES Sensitivity, specificity, positive and negative predictive values (PPV and NPV), overall accuracy, positive and negative likelihood ratios (+LR, -LR) and post (sweat conductivity (SC)) test probability were calculated to assess SC performance. RESULTS 1193 participants were included, 68 with and 1108 without CF, and 17 with intermediate values. The mean (SD) age was 48 (19.2) days, ranging from 15 to 90 days. SC yielded sensitivity of 98.5% (95% CI 95.7 to 100), specificity of 99.9% (95% CI 99.7 to 100), PPV of 98.5% (95% CI 95.7 to 100) and NPV of 99.9% (95% CI 99.7 to 100), overall accuracy of 99.8% (95% CI 99.6 to 100), +LR of 1091.7 (95% CI 153.8 to 7744.9) and -LR of 0.01 (95% CI 0.00 to 0.10). After a positive and negative sweat conductivity result, the patient's probability of CF increases around 350 times and drops to virtually zero, respectively. CONCLUSION Sweat conductivity had excellent accuracy in ruling in or ruling out CF after positive two-tiered immunoreactive trypsinogen among newborns and very young infants.
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Affiliation(s)
- Renata Marcos Bedran
- Faculty of Medicine, Department of Pediatrics, and Cystic Fibrosis Clinic, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Cristina Gonçalves Alvim
- Faculty of Medicine, Department of Pediatrics, and Cystic Fibrosis Clinic, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Olívia Gonçalves Sader
- Faculty of Medicine, Department of Pediatrics, and Cystic Fibrosis Clinic, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - José Vicente Alves Júnior
- Centre for Newborn Screening and Genetic Diagnosis, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fernando Henrique Pereira
- Centre for Newborn Screening and Genetic Diagnosis, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Daniela Magalhães Nolasco
- Centre for Newborn Screening and Genetic Diagnosis, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Linjie Zhang
- Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Paulo Camargos
- Faculty of Medicine, Department of Pediatrics, and Cystic Fibrosis Clinic, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Gur M, Bar-Yoseph R, Hanna M, Abboud D, Keidar Z, Palchan T, Toukan Y, Masarweh K, Alisha I, Zuckerman-Levin N, Bentur L. Effect of Trikafta on bone density, body composition and exercise capacity in CF: A pilot study. Pediatr Pulmonol 2023; 58:577-584. [PMID: 36372909 PMCID: PMC10100338 DOI: 10.1002/ppul.26243] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/26/2022] [Accepted: 11/05/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND While the positive effect of Trikafta on cystic fibrosis (CF) pulmonary disease is well established, there is limited data about its effect on bone mineral density (BMD), body composition and exercise capacity. METHODS A pilot single center study. BMD and body composition were measured three months after the initiation of Trikafta (study group) and compared to values obtained 2 years earlier. CF patients not treated with Trikafta, for whom BMD was measured 2 years apart, served as controls. Spirometry, lung clearance index (LCI), sweat test, six-min walk test (6MWT) and cardio-pulmonary exercise test (CPET) were performed before and three months after the initiation of Trikafta. RESULTS Nine study patients, aged 18.6 ± 4.7 years, and nine controls. For the study group, BMI and hip and spine BMD increased significantly (19.4 ± 2.6 to 20.3 ± 2.19 BMI, p = 0.05; 0.73 ± 0.098 to 0.81 ± 0.12 gr/cm2 hip, p = 0.017; 0.76 ± 0.14 to 0.82 ± 0.14 gr/cm2 spine, p = 0.025). For the control group, there was no difference in hip or spine BMD. Lean body mass, %fat z-score and fat mass/height2 z-score increased significantly (34770.23 ± 10521.21 to 37430.16 ± 10330.09gr, p = 0.017; -0.8 ± 0.75 to 0.46 ± 0.58, p = 0.012; and -0.98 ± 0.66 to -0.04 ± 0.51, p = 0.025, respectively). 6MWT improved from 541.1 ± 48.9 to 592.9 ± 54.5 m (p = 0.046). As expected, FEV1%pred increased (p = 0.008) and sweat chloride decreased significantly (p = 0.017). In CPET, VE/VCO2 improved, indicating better ventilatory efficiency. CONCLUSIONS To the best of our knowledge, this is the first study evaluating the metabolic effects of Trikafta. The results are encouraging and offer hope beyond the well-established effect on pulmonary disease. Larger long-term studies are warranted to unpin the underlying physiological mechanisms.
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Affiliation(s)
- Michal Gur
- Pediatric Pulmonary Institute and CF Center, Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonary Institute and CF Center, Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Moneera Hanna
- Pediatric Pulmonary Institute and CF Center, Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Dana Abboud
- Pediatric Pulmonary Institute and CF Center, Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Zohar Keidar
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Nuclear Medicine Institute, Rambam Health Care Campus, Haifa, Israel
| | - Tala Palchan
- Nuclear Medicine Institute, Rambam Health Care Campus, Haifa, Israel
| | - Yazeed Toukan
- Pediatric Pulmonary Institute and CF Center, Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Kamal Masarweh
- Pediatric Pulmonary Institute and CF Center, Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Irit Alisha
- Pediatric Pulmonary Institute and CF Center, Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Nehama Zuckerman-Levin
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Pediatric Diabetes Unit, Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Lea Bentur
- Pediatric Pulmonary Institute and CF Center, Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Ray TR, Ivanovic M, Curtis PM, Franklin D, Guventurk K, Jeang WJ, Chafetz J, Gaertner H, Young G, Rebollo S, Model JB, Lee SP, Ciraldo J, Reeder JT, Hourlier-Fargette A, Bandodkar AJ, Choi J, Aranyosi AJ, Ghaffari R, McColley SA, Haymond S, Rogers JA. Soft, skin-interfaced sweat stickers for cystic fibrosis diagnosis and management. Sci Transl Med 2021; 13:eabd8109. [PMID: 33790027 PMCID: PMC8351625 DOI: 10.1126/scitranslmed.abd8109] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 03/02/2021] [Indexed: 12/14/2022]
Abstract
The concentration of chloride in sweat remains the most robust biomarker for confirmatory diagnosis of cystic fibrosis (CF), a common life-shortening genetic disorder. Early diagnosis via quantitative assessment of sweat chloride allows prompt initiation of care and is critically important to extend life expectancy and improve quality of life. The collection and analysis of sweat using conventional wrist-strapped devices and iontophoresis can be cumbersome, particularly for infants with fragile skin, who often have insufficient sweat production. Here, we introduce a soft, epidermal microfluidic device ("sweat sticker") designed for the simple and rapid collection and analysis of sweat. Intimate, conformal coupling with the skin supports nearly perfect efficiency in sweat collection without leakage. Real-time image analysis of chloride reagents allows for quantitative assessment of chloride concentrations using a smartphone camera, without requiring extraction of sweat or external analysis. Clinical validation studies involving patients with CF and healthy subjects, across a spectrum of age groups, support clinical equivalence compared to existing device platforms in terms of accuracy and demonstrate meaningful reductions in rates of leakage. The wearable microfluidic technologies and smartphone-based analytics reported here establish the foundation for diagnosis of CF outside of clinical settings.
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Affiliation(s)
- Tyler R Ray
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, HI 96822, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60202, USA
| | - Maja Ivanovic
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Paul M Curtis
- Department of Chemical and Biological Engineering, Northwestern University, Evanston, IL 60202, USA
| | - Daniel Franklin
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60202, USA
| | - Kerem Guventurk
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60202, USA
| | - William J Jeang
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60202, USA
| | - Joseph Chafetz
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60202, USA
| | - Hannah Gaertner
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60202, USA
| | - Grace Young
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60202, USA
| | - Steve Rebollo
- Pritzker School of Molecular Engineering and Department of Physics, University of Chicago, Chicago, IL 60637, USA
| | - Jeffrey B Model
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA
- Epicore Biosystems Inc., Cambridge, MA 02139, USA
| | - Stephen P Lee
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA
- Epicore Biosystems Inc., Cambridge, MA 02139, USA
| | - John Ciraldo
- Micro/Nano Fabrication Facility (NUFAB) Northwestern University, Evanston, IL 60202, USA
| | - Jonathan T Reeder
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA
| | - Aurélie Hourlier-Fargette
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA
- Université de Strasbourg, CNRS, Institut Charles Sadron UPR22, F-67000, Strasbourg 67034, France
| | - Amay J Bandodkar
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA
| | - Jungil Choi
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA
- School of Mechanical Engineering, Kookmin University, Seoul 02707, Republic of Korea
| | - Alexander J Aranyosi
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA
- Epicore Biosystems Inc., Cambridge, MA 02139, USA
| | - Roozbeh Ghaffari
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60202, USA
- Epicore Biosystems Inc., Cambridge, MA 02139, USA
| | - Susanna A McColley
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Division of Pulmonary and Sleep Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Shannon Haymond
- Department of Pathology, Northwestern Feinberg School of Medicine, Chicago, IL 60611, USA
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA.
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60202, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60202, USA
- Epicore Biosystems Inc., Cambridge, MA 02139, USA
- Department of Mechanical Engineering, Department of Electrical and Computer Engineering, Department of Chemistry, Northwestern University, Evanston, IL 60202, USA
- Department of Neurological Surgery Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Nagy B, Bene Z, Fejes Z, Heltshe SL, Reid D, Ronan NJ, McCarthy Y, Smith D, Nagy A, Joseloff E, Balla G, Kappelmayer J, Macek M, Bell SC, Plant BJ, Amaral MD, Balogh I. Human epididymis protein 4 (HE4) levels inversely correlate with lung function improvement (delta FEV 1) in cystic fibrosis patients receiving ivacaftor treatment. J Cyst Fibros 2019; 18:271-277. [PMID: 30268371 DOI: 10.1016/j.jcf.2018.08.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/28/2018] [Accepted: 08/28/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND We have recently shown that human epididymis protein 4 (HE4) levels correlate with the severity of cystic fibrosis (CF) lung disease. However, there are no data on how HE4 levels alter in patients receiving CFTR modulating therapy. METHODS In this retrospective clinical study, 3 independent CF patient cohorts (US-American: 29, Australian: 12 and Irish: 19 cases) were enrolled carrying at least one Class III CFTR CF-causing mutation (p.Gly551Asp) and being treated with CFTR potentiator ivacaftor. Plasma HE4 was measured by immunoassay before treatment (baseline) and 1-6 months after commencement of ivacaftor, and were correlated with FEV1 (% predicted), sweat chloride, C-reactive protein (CRP) and body mass index (BMI). RESULTS After 1 month of therapy, HE4 levels were significantly lower than at baseline and remained decreased up to 6 months. A significant inverse correlation between absolute and delta values of HE4 and FEV1 (r = -0.5376; P < .001 and r = -0.3285; P < .001), was retrospectively observed in pooled groups, including an independent association of HE4 with FEV1 by multiple regression analysis (β = -0.57, P = .019). Substantial area under the receiver operating characteristic curve (ROC-AUC) value was determined for HE4 when 7% mean change of FEV1 (0.722 [95% CI 0.581-0.863]; P = .029) were used as classifier, especially in the first 2 months of treatment (0.806 [95% CI 0.665-0.947]; P < .001). CONCLUSIONS This study shows that plasma HE4 levels inversely correlate with lung function improvement in CF patients receiving ivacaftor. Overall, this potential biomarker may be of value for routine clinical and laboratory follow-up of CFTR modulating therapy.
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Affiliation(s)
- Béla Nagy
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| | - Zsolt Bene
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsolt Fejes
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Sonya L Heltshe
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - David Reid
- QIMR Berghofer Medical Research Institute and The Prince Charles Hospital, Brisbane, Australia
| | - Nicola J Ronan
- Cork Adult Cystic Fibrosis Centre, Cork University Hospital, Cork, Ireland
| | - Yvonne McCarthy
- Cork Adult Cystic Fibrosis Centre, Cork University Hospital, Cork, Ireland
| | - Daniel Smith
- QIMR Berghofer Medical Research Institute and The Prince Charles Hospital, Brisbane, Australia
| | - Attila Nagy
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | | | - György Balla
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; MTA-DE Vascular Biology, Thrombosis and Hemostasis Research Group, Hungarian Academy of Sciences, Debrecen, Hungary
| | - János Kappelmayer
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Milan Macek
- Department of Biology and Medical Genetics, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Scott C Bell
- QIMR Berghofer Medical Research Institute and The Prince Charles Hospital, Brisbane, Australia
| | - Barry J Plant
- Cork Adult Cystic Fibrosis Centre, Cork University Hospital, Cork, Ireland
| | - Margarida D Amaral
- University of Lisboa, Faculty of Sciences, BioISI-Biosystems & Integrative Sciences Institute, Lisboa, Portugal
| | - István Balogh
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Division of Clinical Genetics, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Standardized clinical criteria and sweat test combined as a tool to diagnose Cystic Fibrosis. Heliyon 2018; 4:e01050. [PMID: 30582056 PMCID: PMC6299035 DOI: 10.1016/j.heliyon.2018.e01050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/29/2018] [Accepted: 12/11/2018] [Indexed: 11/23/2022] Open
Abstract
Context CF is under-diagnosed in Ecuador; one out of every 11,252 live births born in Ecuador could have CF. Aim To analyze the clinical findings, based on previously established criteria, with the results of the sweat test, in circumstances where we do not have the routine molecular study. Methods Epidemiological, observational, analytic, cross-sectional study. It analyzed 180 patients clinically suspected of CF. Inclusion criteria: children of both sexes older than 30 days and younger than 12 years, who meet at least three clinical criteria suggestive for CF, outpatient and referred by a specialist physician who made a preliminary diagnosis. This is a pilot study. Results The combination of criteria pneumonia, chronic cough and chronic obstructive bronchial syndrome is the most frequent, with not a significant relationship with a positive sweat test. On the contrary, a significant relationship was found between the clinical combinations of pneumonia with cough and rhinosinusitis; pneumonia with cough; presence of Pseudomonas aeruginosa; and pneumonia with digital cough and clubbing, so it is recommended to perform the test in all these associations. The most frequent clinical criterion for the reference and performance of the electrolyte test in sweat is pneumonia to repeat for two or more episodes. Conclusion Clinical combinations of pneumonia with cough and rhinosinusitis; pneumonia with cough; presence of Pseudomonas aeruginosa; and pneumonia with digital cough and clubbing are pathognomonic for CF and indication for the sweat test. The predictive performance in CF diagnosis, defined as compatible clinical presence plus high values of chloride in sweat test, was 91.1%.
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