Objectives: To better understand response to IV therapy for PEx by exploring how multiple parameters measured early in treatment relate to later response, clinical course and identify which measures may be of most future use. Methods: A single centre observational study assessed early response to IVs. Clinical(lung function, 24hr sputum volume, Respiratory rate(RR)), microbiological, inflammatory(serum/sputum biomarkers) and patient related(CFRSD -CRISS, Fitbit TM activity/sleep)parameters were assessed on admission(D0),day 5(D5) and end of IV treatment(EOT). The relationship between early parameters(D0/D5), parameters at EOT and clinical course at 1,3 and 12 months was examined(Spearman R correlation/Survival analysis). Results: 31 participants(13M:18F) with mean(SD)age 30(7) years and mean FEV1 61(25)% enrolled. Mean(SD)IV length was 12(4)days. Significant improvements(p<0.05) in FEV1 (%) , FEF25-75%, 24hr sputum, step count, sedentary minutes, CFRSD-CRISS, RR and serum biomarkers(CRP, WCC)were seen by D5 . Sleep duration improved by 69 minutes. DO/D5 parameters correlated with those measured at EOT,1 and 3 months. D0 RR correlated with FEF25-75% at 1/3 months, D5 02 saturations with FEV1(%)at EOT and D5 Step count and distance walked with FEV1(%)/FeF25-75% at 1/3 months(r>0.5). No single parameter correlated with IV duration. DO parameters associated with a longer time to next IVs(TUNE) were a CRP<5mg/L(74 vs 35 days)(HR 0.2,P=0.0012),step count >1500(82 vs 58 days)(HR 0.67,p=0.46) and 24hr sputum volume ≤60mls(101 vs 41 days )(HR 0.11,P=0.001). On D5 a ≥10% increase in FEV1(80 vs 60 days)(HR 0.65,p=0.44),Sputum volume<35mls(89 vs 43 days)(HR 0.21,p=0.04) and a >50% drop in 24hr sputum(83 vs 68 days)(HR 0.86,p=0.7) were also associated with a longer TUNE. Conclusion: Multi-dimensional parameters, including activity measured early in IV therapy relate to later outcomes and may predict clinical course. Sputum microbiology and inflammatory biomarker analysis is in progress.
|Publication status||Accepted - 2018|
|Event||European Cystic Fibrosis Society Conference, 2018 - Belgrade, Serbia|
Duration: 06 Jun 2018 → …
|Conference||European Cystic Fibrosis Society Conference, 2018|
|Period||06/06/2018 → …|
Addy, C., Bradley, J., Elborn, J., Bradbury, I., & Downey, D. (Accepted/In press). Early multi-dimensional assessment of Parameters to assess Response to Intra-Venous Antibiotic Treatment for pulmonary Exacerbations: The PRIVATE Study.. Abstract from European Cystic Fibrosis Society Conference, 2018, Belgrade, Serbia.