Acute Pulmonary Exacerbation Phenotypes in Patients with Cystic Fibrosis
Rationale: The etiology of cystic fibrosis (CF) pulmonary exacerbations (PEx) is likely multifactorial with viral, bacterial, and non-infectious pathways contributing. Objectives: To determine whether viral infection status and CRP (C-reactive protein) can classify subphenotypes of PEx that differ in outcomes and biomarker profiles. Methods: Patients were recruited at time of admission for a PEx. Nasal swabs and sputum samples were collected and processed using the respiratory panel of the FilmArray multiplex polymerase chain reaction (PCR). Serum and plasma biomarkers were measured. PEx were classified using serum CRP and viral PCR: "pauci-inflammatory" if CRP < 5 mg/L, "non-viral with systemic inflammation" if CRP ⩾ 5 mg/L and no viral infection detected by PCR and "viral with systemic inflammation" if CRP ⩾ 5 mg/L and viral infection detected by PCR. Results: Discovery cohort (n = 59) subphenotype frequencies were 1) pauci-inflammatory (37%); 2) non-viral with systemic inflammation (41%); and 3) viral with systemic inflammation (22%). Immunoglobulin G, immunoglobulin M, interleukin-10, interleukin-13, serum calprotectin, and CRP levels differed across phenotypes. Reduction from baseline in forced expiratory volume in 1 second as percent predicted (FEV1pp) at onset of exacerbation differed between non-viral with systemic inflammation and viral with systemic inflammation (-6.73 ± 1.78 vs. -13.5 ± 2.32%; P = 0.025). Non-viral with systemic inflammation PEx had a trend toward longer duration of intravenous antibiotics versus pauci-inflammation (18.1 ± 1.17 vs. 14.8 ± 1.19 days, P = 0.057). There were no differences in percent with lung function recovery to <10% of baseline FEV1pp. Similar results were seen in local and external validation cohorts comparing a pauci-inflammatory to viral/non-viral inflammatory exacerbation phenotypes. Conclusions: Subphenotypes of CF PEx exist with differences in biomarker profile, clinical presentation, and outcomes.
| Errataetall: |
CommentIn: Ann Am Thorac Soc. 2022 Nov;19(11):1799-1801. - PMID 36318079 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:19 |
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| Enthalten in: |
Annals of the American Thoracic Society - 19(2022), 11 vom: 05. Nov., Seite 1818-1826 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Carter, Suzanne C [VerfasserIn] |
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| Links: |
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| Themen: |
9007-41-4 |
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| Anmerkungen: |
Date Completed 03.11.2022 Date Revised 02.05.2023 published: Print CommentIn: Ann Am Thorac Soc. 2022 Nov;19(11):1799-1801. - PMID 36318079 Citation Status MEDLINE |
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| doi: |
10.1513/AnnalsATS.202111-1266OC |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM342349449 |
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| 100 | 1 | |a Carter, Suzanne C |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Acute Pulmonary Exacerbation Phenotypes in Patients with Cystic Fibrosis |
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| 500 | |a Date Revised 02.05.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: Ann Am Thorac Soc. 2022 Nov;19(11):1799-1801. - PMID 36318079 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Rationale: The etiology of cystic fibrosis (CF) pulmonary exacerbations (PEx) is likely multifactorial with viral, bacterial, and non-infectious pathways contributing. Objectives: To determine whether viral infection status and CRP (C-reactive protein) can classify subphenotypes of PEx that differ in outcomes and biomarker profiles. Methods: Patients were recruited at time of admission for a PEx. Nasal swabs and sputum samples were collected and processed using the respiratory panel of the FilmArray multiplex polymerase chain reaction (PCR). Serum and plasma biomarkers were measured. PEx were classified using serum CRP and viral PCR: "pauci-inflammatory" if CRP < 5 mg/L, "non-viral with systemic inflammation" if CRP ⩾ 5 mg/L and no viral infection detected by PCR and "viral with systemic inflammation" if CRP ⩾ 5 mg/L and viral infection detected by PCR. Results: Discovery cohort (n = 59) subphenotype frequencies were 1) pauci-inflammatory (37%); 2) non-viral with systemic inflammation (41%); and 3) viral with systemic inflammation (22%). Immunoglobulin G, immunoglobulin M, interleukin-10, interleukin-13, serum calprotectin, and CRP levels differed across phenotypes. Reduction from baseline in forced expiratory volume in 1 second as percent predicted (FEV1pp) at onset of exacerbation differed between non-viral with systemic inflammation and viral with systemic inflammation (-6.73 ± 1.78 vs. -13.5 ± 2.32%; P = 0.025). Non-viral with systemic inflammation PEx had a trend toward longer duration of intravenous antibiotics versus pauci-inflammation (18.1 ± 1.17 vs. 14.8 ± 1.19 days, P = 0.057). There were no differences in percent with lung function recovery to <10% of baseline FEV1pp. Similar results were seen in local and external validation cohorts comparing a pauci-inflammatory to viral/non-viral inflammatory exacerbation phenotypes. Conclusions: Subphenotypes of CF PEx exist with differences in biomarker profile, clinical presentation, and outcomes | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a cystic fibrosis | |
| 650 | 4 | |a exacerbation | |
| 650 | 4 | |a pauci-inflammatory | |
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| 650 | 4 | |a viral infection | |
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| 650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
| 650 | 7 | |a Biomarkers |2 NLM | |
| 700 | 1 | |a Franciosi, Alessandro N |e verfasserin |4 aut | |
| 700 | 1 | |a O'Shea, Kate M |e verfasserin |4 aut | |
| 700 | 1 | |a O'Carroll, Orla M |e verfasserin |4 aut | |
| 700 | 1 | |a Sharma, Ashutosh |e verfasserin |4 aut | |
| 700 | 1 | |a Bell, Aoife |e verfasserin |4 aut | |
| 700 | 1 | |a Keogan, Brian |e verfasserin |4 aut | |
| 700 | 1 | |a O'Reilly, Paul |e verfasserin |4 aut | |
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| 700 | 1 | |a Law, Sheonagh M |e verfasserin |4 aut | |
| 700 | 1 | |a Gray, Robert D |e verfasserin |4 aut | |
| 700 | 1 | |a Hisert, Katherine B |e verfasserin |4 aut | |
| 700 | 1 | |a Singh, Pradeep K |e verfasserin |4 aut | |
| 700 | 1 | |a Cooke, Gordon |e verfasserin |4 aut | |
| 700 | 1 | |a Grogan, Brenda |e verfasserin |4 aut | |
| 700 | 1 | |a De Gascun, Cillian F |e verfasserin |4 aut | |
| 700 | 1 | |a Gallagher, Charles G |e verfasserin |4 aut | |
| 700 | 1 | |a Nicholson, Trevor T |e verfasserin |4 aut | |
| 700 | 1 | |a Quon, Bradley S |e verfasserin |4 aut | |
| 700 | 1 | |a McKone, Edward F |e verfasserin |4 aut | |
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