Details

Autor(en) / Beteiligte

• Perrem, Lucy
• Stanojevic, Sanja
• Solomon, Melinda
• Grasemann, Hartmut
• Sweezey, Neil
• Waters, Valerie
• Sanders, Don B
• Davis, Stephanie D
• Ratjen, Felix

Titel

Evaluation of clinically relevant changes in the lung clearance index in children with cystic fibrosis and healthy controls

Ist Teil von

• Thorax, 2023-04, Vol.78 (4), p.362-367

Ort / Verlag

England: BMJ Publishing Group Ltd and British Thoracic Society

Erscheinungsjahr

2023

Quelle

MEDLINE

Beschreibungen/Notizen

• BackgroundThe limits of reproducibility of the lung clearance index (LCI) are higher in children with cystic fibrosis (CF) compared with healthy children, and it is currently unclear what defines a clinically meaningful change.MethodsIn a prospective multisite observational study of children with CF and healthy controls (HCs), we measured LCI, FEV1% predicted and symptom scores at quarterly visits over 2 years. Two reviewers performed a detailed review of visits to evaluate the frequency that between visit LCI changes outside ±10%, ±15%, ±20% represented a clinically relevant signal. In the setting of acute respiratory symptoms, we used a generalised estimating equation model, with a logit link function to determine the ability of LCI worsening at different thresholds to predict failure of lung function recovery at follow-up.ResultsClinically relevant LCI changes outside ±10%, ±15% and ±20% were observed at 25.7%, 15.0% and 8.3% of CF visits (n=744), respectively. The proportions of LCI changes categorised as noise, reflecting biological variability, were comparable between CF and HC at the 10% (CF 9.9% vs HC 13.0%), 15% (CF 4.3% vs HC 3.1%) and 20% (CF 2.4% vs HC 1.0%) thresholds. Compared with symptomatic CF visits without a worsening in LCI, events with ≥10% LCI increase were more likely to fail to recover baseline LCI at follow-up.ConclusionThe limits of reproducibility of the LCI in healthy children can be used to detect clinically relevant changes and thus inform clinical care in children with CF.