A point-of-care neutrophil elastase activity assay identifies bronchiectasis severity, airway infection and risk of exacerbation
Por:
Shoemark, A, Cant, E, Carreto, L, Smith, A, Oriano, M, Keir, HR, Perea, L, Canto, E, Terranova, L, Vidal, S, Moffitt, K, Aliberti, S, Sibila, O, Chalmers, JD
Publicada:
1 jun 2019
Resumen:
Introduction: Neutrophil elastase activity in sputum can identify patients at high risk of airway infection and exacerbations in bronchiectasis. Application of this biomarker in clinical practice is limited, because no point-of-care test is available. We tested whether a novel semi-quantitative lateral flow device (neutrophil elastase airway test stick - NEATstik (R)) can stratify bronchiectasis patients according to severity, airway infection and exacerbation risk.
Methods: Sputum samples from 124 patients with stable bronchiectasis enrolled in the UK and Spain were tested using the NEATstik (R), which scores neutrophil elastase concentration from 0 (<8 mu g.mL(-1) elastase activity) to 10 (maximum detectable neutrophil elastase activity). High neutrophil elastase activity was regarded as a NEATstik (R) grade >6. Severity of disease, airway infection from sputum culture and exacerbations over the 12 months were recorded. An independent validation was conducted in 50 patients from Milan, Italy.
Measurements and main results: Patients had a median age of 69 years and forced expiratory volume in 1 s (FEV1) 69%. High neutrophil elastase activity was associated with worse bronchiectasis severity using the bronchiectasis severity index (p=0.0007) and FEV1 (p=0.02). A high NEATstik (R) grade was associated with a significant increase in exacerbation frequency, incident rate ratio 2.75 (95% CI 1.63-4.64, p<0.001). The median time to next exacerbation for patients with a NEATstik (R) grade >6 was 103 days compared to 278 days. The hazard ratio was 2.59 (95% CI 1.71-3.94, p<0.001). Results were confirmed in the independent validation cohort.
Conclusions: A novel lateral flow device provides assessment of neutrophil elastase activity from sputum in minutes and identifies patients at increasing risk of airway infection and future exacerbations.
Filiaciones:
Shoemark, A:
Univ Dundee, Ninewells Hosp & Med Sch, Scottish Ctr Resp Res, Dundee, Scotland
Cant, E:
Univ Dundee, Ninewells Hosp & Med Sch, Scottish Ctr Resp Res, Dundee, Scotland
Carreto, L:
Hosp Prof Fernando Fonseca HFF, Lisbon, Portugal
Smith, A:
Univ Cambridge, Cambridge, England
Oriano, M:
Univ Milan, Dept Pathophysiol & Transplantat, Milan, Italy
Fdn IRCCS Ca Granda Osped Maggiore Policlin, Resp Unit, Milan, Italy
Fdn IRCCS Ca Granda Osped Maggiore Policlin, Cyst Fibrosis Adult Ctr, Milan, Italy
Keir, HR:
Univ Dundee, Ninewells Hosp & Med Sch, Scottish Ctr Resp Res, Dundee, Scotland
Perea, L:
Hosp Santa Creu & Sant Pau, Biomed Res Inst IIB St Pau Barcelona, Barcelona, Spain
Canto, E:
Hosp Santa Creu & Sant Pau, Biomed Res Inst IIB St Pau Barcelona, Barcelona, Spain
Terranova, L:
Univ Milan, Dept Pathophysiol & Transplantat, Milan, Italy
Fdn IRCCS Ca Granda Osped Maggiore Policlin, Resp Unit, Milan, Italy
Fdn IRCCS Ca Granda Osped Maggiore Policlin, Cyst Fibrosis Adult Ctr, Milan, Italy
Vidal, S:
Hosp Santa Creu & Sant Pau, Biomed Res Inst IIB St Pau Barcelona, Barcelona, Spain
Moffitt, K:
Proaxsis Ltd, Belfast, Antrim, North Ireland
Aliberti, S:
Univ Milan, Dept Pathophysiol & Transplantat, Milan, Italy
Fdn IRCCS Ca Granda Osped Maggiore Policlin, Resp Unit, Milan, Italy
Fdn IRCCS Ca Granda Osped Maggiore Policlin, Cyst Fibrosis Adult Ctr, Milan, Italy
Sibila, O:
Hosp Santa Creu & Sant Pau, Biomed Res Inst IIB St Pau Barcelona, Barcelona, Spain
Chalmers, JD:
Univ Dundee, Ninewells Hosp & Med Sch, Scottish Ctr Resp Res, Dundee, Scotland
Bronze, Green Published
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