scholarly journals Biomarkers to identify sputum eosinophilia in different adult asthma phenotypes

2015 ◽  
Vol 46 (3) ◽  
pp. 688-696 ◽  
Author(s):  
Guus A. Westerhof ◽  
Daniël A. Korevaar ◽  
Marijke Amelink ◽  
Selma B. de Nijs ◽  
Jantina C. de Groot ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Operating Characteristics ◽  
Total Ige ◽  
Adult Asthma ◽  
Asthma Phenotypes ◽  
Sputum Eosinophilia ◽  
Asthma Patients ◽  
Outpatient Departments ◽  
Nonobese Patients ◽  
Blood Eosinophils

Several biomarkers have been used to assess sputum eosinophilia in asthma. It has been suggested that the diagnostic accuracy of these biomarkers might differ between asthma phenotypes. We investigated the accuracy of biomarkers in detecting sputum eosinophilia (≥3%) in different adult asthma phenotypes.Levels of eosinophils in blood and sputum, exhaled nitric oxide fraction (FeNO) and total immunoglobulin (Ig)E from 336 adult patients, enrolled in three prospective observational clinical trials and recruited at five pulmonology outpatient departments, were analysed. Areas under the receiver operating characteristics curves (AUC) for detecting sputum eosinophilia were calculated and compared between severe and mild, obese and nonobese, atopic and nonatopic and (ex-)smoking and never-smoking asthma patients.Sputum eosinophilia was present in 116 patients (35%). In the total group the AUC was 0.83 (95% CI 0.78–0.87) for blood eosinophils, 0.82 (0.77–0.87) for FeNO and 0.69 (0.63–0.75) for total IgE. AUCs were similar for blood eosinophils and FeNO between different phenotypes. Total IgE was less accurate in detecting sputum eosinophilia in atopic and obese patients than in nonatopic and nonobese patients.Blood eosinophils and FeNO had comparable diagnostic accuracy (superior to total IgE) in identifying sputum eosinophilia in adult asthma patients, irrespective of asthma phenotype such as severe, nonatopic, obese and smoking-related asthma.

Identifying the Clinical Pattern of Eosinophilic and Non-Eosinophilic Asthma subtype in adult patients with Bronchial Asthma

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Maged Mohammed Refaat ◽  
Dina Sayed Sheha ◽  
Riham Hazem Raaft ◽  
Maged Mohamed Refaat ◽  
Heba Eid Farhat Abo Alia ◽  
...  
Keyword(s):  
Bronchial Asthma ◽  
Skin Prick Testing ◽  
Nasal Endoscopy ◽  
Asthma Control Test ◽  
Eosinophilic Asthma ◽  
Total Ige ◽  
Common Chronic Disease ◽  
Sputum Eosinophilia ◽  
Asthma Patients ◽  
The Mean

Abstract Background Context:- Asthma is a heterogenous disease with various phenotypes, it is the most common chronic disease characterized by airway limitation due to bronchospasm and airway inflammation associated with excessive mucus secretion from agitated mucus gland that occur due to air way hyper responiveness. Purpose of the study Comparison between eosinophilic and non-eosinophilic asthma patients. Patients and Methods 100 bronchial asthma patients of age ≥ 18 years old divided into2 groups according to blood eosinophilia. All patients were subjected to: history. Total Asthma Control Test. Spirometry. Sputum eosinophil count. IgE levels 6-Skin prick testing (SPT). Nasal endoscopy. Results the mean age of all patients was (35.4 ± 12.8) years, majority (61%) of patients were males,; the mean ACT score was (18.7 ± 2); 39% of cases have obstructive pattern by spirometry, 39% of cases had abnormal nasal endoscopy, SPT had significant relation with asthma, there is significant correlation between total IGE,sputum eosinophilia with eosinophilic asthma. Conclusion Blood eosinophils had the highest accuracy in the identification of sputum eosinophilia in asthma. Total IgE values and sutum eosinophilia were markedly increased in patients with eosinophilic asthma more than patients with non-eosinophilic asthma.

scholarly journals Osteopontin contributes to late-onset asthma phenotypes in adult asthma patients

2020 ◽  
Vol 52 (2) ◽  
pp. 253-265
Author(s):  
Hoang Kim Tu Trinh ◽  
Thuy Van Thao Nguyen ◽  
Seo-Hee Kim ◽  
Thi Bich Tra Cao ◽  
Quoc Quang Luu ◽  
...  
Keyword(s):  
Late Onset ◽  
Adult Asthma ◽  
Asthma Phenotypes ◽  
Asthma Patients

Real-World Data Evaluation Of Total IgE, Specific IgE And Omalizumab Therapy In A Cohort Of Allergic Asthma Patients Treated In A Community-Based Practice

2020 ◽  
Author(s):  
Fortune O Alabi
Keyword(s):  
Allergic Asthma ◽  
Specific Ige ◽  
Forced Expiratory Volume ◽  
Act Scores ◽  
Asthma Control Test ◽  
Real World Data ◽  
Total Ige ◽  
Prick Test ◽  
Negative Results ◽  
Asthma Patients

Objective: In this study, we: (1) evaluated the correlation between total IgE and the presence of specific IgE; (2) compared the characteristics of patients with positive specific IgE to those with negative specific IgE; and, (3) analyzed the allergic testing results of patients on omalizumab and reported the effect of omalizumab on forced expiratory volume (FEV1) and asthma control test (ACT) results. Methods: Data from patients diagnosed with allergic asthma and seen at Florida Lung, Asthma & Sleep Specialists (FLASS) between January 2016 and June 2019 were analyzed. Parameters evaluated were total IgE, and levels of specific IgE to antigens in the ImmunoCAP test and skin prick test (SPT). Additional parameters for patients on omalizumab therapy for at least 6 months were FEV1, % predicted FEV1 and ACT results. Results: A total of 475 patients (114 males, 361 females) met the inclusion criteria. The mean age was 53 years (range: 17 to 89 years). Of these, 36 patients were not included in the analysis due to incomplete data. Mean total IgE was higher in patients with positive ImmunoCAP results compared to those with negative results (396 KU/L vs. 81.3 KU/L). There was a significant positive correlation between total IgE and levels of positive specific IgE in the ImmunoCAP test (p<0.0001, r=0.36, n=213 patients). The correlation between total IgE and levels of positive allergens in SPT was not significant (p=0.15, n=44 patients) Two positive reactions to allergens were seen in 22% of ImmunoCAP tests and 13% of SPT tests. There was no statistically significant improvement in FEV1 (p=0.097, CI -0.17 to 0.02) and % predicted FEV1 (p=0.109, CI -6.63 to 0.70) in patients who used omalizumab for at least 6 months. There was a statistically significant improvement in ACT scores (p=0.031, CI -4.21 to -0.21) in patients who used omalizumab for at least 6 months. Conclusion: Allergic asthma could be seen in patients who had an absence of specific IgE in ImmunoCAP and a negative reaction to SPT. The benefit of omalizumab therapy is not limited to allergic asthma patients with positive specific IgE.

scholarly journals Development and validation of an ECG-based cardiac syncope risk calculator

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Zimmermann ◽  
J Du Fay De Lavallaz ◽  
T Nestelberger ◽  
D Gualandro ◽  
I Strebel ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Information ◽  
Funding Source ◽  
Risk Calculator ◽  
Operating Characteristics ◽  
Derivation Cohort ◽  
Cardiac Syncope ◽  
Predicted Probability ◽  
Ecg Criteria ◽  
Rule Out

Abstract Background The early diagnosis of cardiac syncope is often challenging. We therefore developed an ECG-based risk calculator as an aid for rapid rule-out or rule-in of cardiac syncope and aimed to validate this decision tool. Methods In a prospective diagnostic international multicenter study (derivation cohort), 2007 patients, 40 years or older, presenting with syncope to the emergency department were recruited. The primary diagnostic outcome, cardiac syncope, was centrally adjudicated by two independent cardiologists using all clinical information obtained during syncope work-up including 12-month follow up. 12-lead ECG was recorded at presentation and read by residents blinded to clinical information. Significant ECG predictors of cardiac syncope were identified using penalized backward selection. Findings were validated in an independent US multicenter cohort with 2'269 syncope patients. Results In the derivation cohort (median age 71 years, 40% women), centrally adjudicated cardiac syncope was present in 267 patients (16%). Seven ECG criteria (rhythm, heart rate, corrected QT-interval, ST-segment depression, atrioventricular-block, bundle-branch-block and ventricular extrasystole/non-sustained ventricular tachycardia) were identified as significant predictors for cardiac syncope and combined into the bAseL Ecg Risk calculaTor for Cardiac Syncope (ALERT-CS). Diagnostic accuracy of ALERT-CS for cardiac syncope, as quantified by the area under the receiver-operating characteristics curve (AUC), was high (0.80, 95%-confidence interval (CI) 0.77–0.83) and significantly higher compared to the EGSYS score (0.73, 95% CI 0.70–0.76, p&lt;0.001). In combination, ALERT-CS significantly increased the AUC of BNP (0.82, 95% CI 0.79–0.85 vs 0.77, 95% CI 0.74–0.81, p=0.003), hs-cTnT (0.84, 95% CI 0.0.81–0.87 vs 0.77, 95% CI 0.74–0.80, p&lt;0.001) and integrated clinical judgment in the ED (0.90, 95% CI 0.89–0.92 vs 0.87, 95% CI 0.84–0.90, p&lt;0.001). A predicted probability for cardiac syncope below 5.5% by ALERT-CS identified 138 patients (8%) eligible for triage towards rapid rule-out of cardiac syncope with a sensitivity of 99%. A predicted probability above 37.5% identified 181 patients (11%) eligible for triage towards rapid rule-in of cardiac syncope with a specificity of 95%. Prognostic verification for 30-day major adverse cardiac events (MACE) showed a high rate of MACE in the rule-in group and a very low rate of MACE in the rule-out group (Figure). External validation (median age 72 years, 48% women) showed similar diagnostic accuracy (AUC 0.76, 95% CI 0.73–0.79) and prognostic results. Conclusion Combining seven ECG criteria within the simple ALERT-CS may aid ED physicians in the early rule-out or rule-in of cardiac syncope. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation

Developing Episodes of Care for Adult Asthma Patients: A Cautionary Tale*†

1998 ◽  
Vol 13 (1) ◽  
pp. 25-35 ◽  
Author(s):  
Amy K. Rosen ◽  
Robert L. Houchens ◽  
Teresa B. Gibson ◽  
Allison Mayer-Oakes
Keyword(s):  
Cautionary Tale ◽  
Adult Asthma ◽  
Asthma Patients ◽  
Episodes Of Care

Abstract 18795: Resting Patient- and Vessel-Specific Myocardial Perfusion Attenuation Patterns Improves Diagnostic Performance of Coronary Computed Tomographic Angiography

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Guanglei Xiong ◽  
Iksung Cho ◽  
Heidi Gransar ◽  
Deeksha Kola ◽  
Kimberly Elmore ◽  
...  
Keyword(s):  
Myocardial Perfusion ◽  
Diagnostic Accuracy ◽  
Coronary Stenosis ◽  
Diagnostic Performance ◽  
Ct Perfusion ◽  
Quantitative Coronary Angiography ◽  
High Grade ◽  
Operating Characteristics ◽  
Luminal Diameter ◽  
Coronary Stenoses

Introduction: Coronary CT angiography (CCTA) demonstrates improved performance for diagnosis of high-grade coronary stenoses, but may be affected by artifacts and overestimation of stenosis severity. Whether the addition of resting myocardial perfusion attenuation patterns subtended by stenosis seen on CCTA improves diagnostic performance has not been examined to date. Methods: We evaluated 127 patients (mean age 53.0, 54.3% male) who underwent CCTA and ICA. Percentage of coronary stenosis was assessed by quantitative coronary angiography (QCA), which served as the reference comparator to CCTA. CCTA stenosis was categorized as 0%, 1-24%, 25-49%, 50-69%, 70-99%, and 100% luminal diameter reduction. Automated software (SmartHeart, Redwood City, CA) was used to measure resting CT perfusion attenuation patterns in myocardial segments by AHA 17-segment model. Segmental CT attenuation values were assigned to territories subtended by left anterior descending (LAD), left circumflex (LCX), and right coronary arteries (RCA). Per-patient and per-vessel analyses were based on highest severity (maximal stenosis, minimal attenuation). On both per-patient and per-vessel basis, logistic regression was devised for CCTA stenosis alone and for CCTA plus resting myocardial attenuation. Diagnostic accuracy and area under the receiver operating characteristics curve (AUC) were determined. Results: Diagnostic accuracy of CCTA alone was 84.0%, 85.5%, 90.4%, and 88.6%, at per-patient, per-LAD, per-LCX and per-RCA level, respectively. In comparison, the accuracy of CCTA plus myocardial attenuation were 89.6%, 91.9%, 95.2%, and 92.7%. The AUCs using CCTA alone to discriminate QCA-confirmed coronary stenoses >70% were 0.823 (95% CI: 0.737-0.909), 0.782 (95% CI: 0.667-0.898), 0.690 (95% CI: 0.503-0.878), and 0.793 (95% CI: 0.640-0.945) for per-patient, per-LAD, per-LCX, and per-RCA analysis, respectively. The AUCs using CCTA plus myocardial attenuation improved to 0.864 (95% CI: 0.765-0.962), 0.881 (95% CI: 0.793-0.968), 0.772 (95% CI: 0.535-1.000), and 0.820 (95% CI: 0.685-0.954). Conclusions: The addition of resting CT myocardial perfusion attenuation patterns improves identification and discrimination of high-grade coronary stenosis by CCTA.

P111 CD-14 gene polymorphism in adult asthma patients with eosinophilic versus neutrophilic sputum in crimea

2016 ◽  
Vol 117 (5) ◽  
pp. S53
Author(s):  
Y. Bisyuk ◽  
A. Kurchenko ◽  
O. Akhtemiichuk ◽  
A. Dubovyi ◽  
L. DuBuske
Keyword(s):  
Gene Polymorphism ◽  
Adult Asthma ◽  
Asthma Patients

scholarly journals Performance of Lactate and CO2-Derived Parameters in Predicting Major Postoperative Complications After Cardiac Surgery With Cardiopulmonary Bypass: Protocol of a Diagnostic Accuracy Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiao-Fen Zhou ◽  
Rong-Guo Yu ◽  
Qian Chen ◽  
Yi-Min Xue ◽  
Han Chen
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Postoperative Complications ◽  
Diagnostic Accuracy ◽  
Partial Pressure ◽  
Low Flow ◽  
Diagnostic Accuracy Study ◽  
Operating Characteristics ◽  
Content Ratio ◽  
Accuracy Study

Background: CO2-derived parameters are increasingly used to identify either low-flow status or anaerobic metabolism in shock resuscitation. However, the performance of CO2-derived parameters in cardiac surgical patients is poorly understood. This study aims to compare the performance of lactate and CO2-derived parameters in predicting major postoperative complications after cardiac surgery with cardiopulmonary bypass.Methods: This is a prospective, single-center, diagnostic accuracy study. All patients who receive elective cardiac surgery involving cardiopulmonary bypass will be screened for study eligibility. Blood samples will be taken for the calculation of CO2-derived parameters, including the venous-arterial difference in CO2 partial pressure (PCO2 gap), venous-arterial difference in CO2 content to arterial-venous O2 content ratio (Cv-aCO2/Ca-vO2), and venous-arterial difference in CO2 partial pressure to arterial-venous O2 content ratio (Pv-aCO2/Ca-vO2) at ICU admission, and 3, 6, and 12 h later. Baseline, perioperative data will be collected daily for 7 days; patients will be followed up for 28 days to collect outcome data. The primary endpoint is the occurrence of major postoperative complications. Receiver-operating characteristics (ROC) curve analysis will be carried out to assess the predictive performance of lactate and CO2-derived parameters. The performance of the ROC curves will be compared.Discussion: The performance of lactate and CO2-derived parameters in predicting major postoperative complications will be investigated in the non-sepsis population, which has not been extensively investigated. Our study will compare the two surrogates of respiratory quotient directly, which is an important strength.Trial Registration: ChiCTR, ChiCTR2000029365. Registered January 26th, 2020, http://www.chictr.org.cn/showproj.aspx?proj=48744.

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