A point-of-care neutrophil elastase activity assay identifies bronchiectasis severity, airway infection and risk of exacerbation
- 31 May 2019
- journal article
- research article
- Published by European Respiratory Society (ERS) in European Respiratory Journal
- Vol. 53 (6), 1900303
- https://doi.org/10.1183/13993003.00303-2019
Abstract
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 (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, p6 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.Keywords
Funding Information
- British Lung Foundation (GSK/BLF Chair)
- European Respiratory Society (EMBARC2)
This publication has 26 references indexed in Scilit:
- Treatable traits in bronchiectasisEuropean Respiratory Journal, 2018
- Characterization of the “Frequent Exacerbator Phenotype” in BronchiectasisAmerican Journal of Respiratory and Critical Care Medicine, 2018
- The independent contribution of Pseudomonas aeruginosa infection to long-term clinical outcomes in bronchiectasisEuropean Respiratory Journal, 2018
- Multidimensional severity assessment in bronchiectasis: an analysis of seven European cohortsThorax, 2016
- Predicting mortality in bronchiectasis using bronchiectasis severity index and FACED scores: a 19-year cohort studyEuropean Respiratory Journal, 2015
- A Comprehensive Analysis of the Impact ofPseudomonas aeruginosaColonisation on Prognosis in Adult BronchiectasisAnnals of the American Thoracic Society, 2015
- The Role of Viral Infection in Pulmonary Exacerbations of Bronchiectasis in AdultsChest, 2015
- Multidimensional approach to non-cystic fibrosis bronchiectasis: the FACED scoreEuropean Respiratory Journal, 2014
- Short- and Long-Term Antibiotic Treatment Reduces Airway and Systemic Inflammation in Non–Cystic Fibrosis BronchiectasisAmerican Journal of Respiratory and Critical Care Medicine, 2012
- Aetiology in adult patients with bronchiectasisRespiratory Medicine, 2007