Impact of Reanalysis of Nitrogen Multiple-Breath Washout on its Relationship with Chest Magnetic Resonance Imaging Findings in Clinically Stable and Pulmonary Exacerbated Children with Cystic Fibrosis

 

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Abstract

Rationale Multiple-breath washout (MBW)-derived lung clearance index (LCI) detects lung disease in children with cystic fibrosis (CF). Correction of a cross-talk error in the software of the MBW device Exhalyzer D in a new software version has generated significant interest regarding its impact on previous MBW findings. Since LCI and chest magnetic resonance imaging (MRI) correlated before in CF children, this study aims to reassess previous MBW data after correction.

Patients/Methods Reanalysis of the main findings from a previously published study comparing MBW and MRI in a pediatric CF cohort by reassessment of nitrogen (N₂) MBW of 61 stable children with CF, 75 age-matched healthy controls (HC), and 15 CF children with pulmonary exacerbation (PEx) in the corrected software version.

Results The corrected LCI (N₂LCI_cor) decreased in the entire cohort (−17.0 (11.2)%), HC (−8.5 (8.2)%), stable CF children (−22.2 (11.1)%), and within the PEx group at baseline, at PEx and after antibiotic therapy (−21.5 (7.3)%; −22.5 (6.1)%; −21.4 (6.6)%; all P<0.01). N₂LCI_cor and N₂LCI_pre correlated with chest MRI scores in stable CF (r=0.70 to 0.84; all P<0.01) without a significant difference between N₂LCI_cor and N₂LCI_pre. Change in LCI from baseline to PEx and from PEx to after therapy decreased from N₂LCI_pre to N₂LCI_cor, but these changes remained significant (all P=0.001).

Discussion/Conclusions Our results indicate that N₂LCI_cor is significantly lower than N₂LCI_pre, but key results published in the original study demonstrating N₂MBW and MRI as complementary methods for clinical surveillance in children with CF remain unaffected.

Zusammenfassung

Hintergrund Der mittels Multiple-Breath Washout (MBW) bestimmte Lung Clearance Index (LCI) erkennt Lungenveränderungen bei Kindern mit zystischer Fibrose (CF). Die Korrektur eines crosstalk-Fehlers in der Software des MBW-Geräts Exhalyzer D in einer neuen Softwareversion hat großes Interesse an den Auswirkungen auf frühere MBW-Ergebnisse geweckt. Da LCI und Magnetresonanztomographie (MRT) bei CF-Kindern früher korrelierten, zielt diese Studie darauf ab, frühere Ergebnisse nach der Korrektur zu reevaluieren.

Patienten/Methoden Reanalyse wichtigster Ergebnisse einer publizierten Studie zum Vergleich von MBW- und MRT-Ergebnissen in pädiatrischer CF-Kohorte mittels Reanalyse von Stickstoff (N₂)-MBWs von 61 stabilen CF-Kindern, 75 altersgleichen gesunden Kontrollen (HC) und 15 CF-Kindern mit pulmonaler Exazerbation (PEx) in der korrigierten Software-Version.

Ergebnisse Signifikante Abnahme des korrigierten LCI (N₂LCI_cor) in Gesamtkohorte (−17.0 (11.2)%), HC (−8.5 (8.2)%), stabilen CF-Kindern (−22.2 (11.1)%) und in der PEx-Gruppe zu Beginn, bei PEx und nach Antibiotikatherapie (−21.5 (7.3)%; −22.5 (6.1)%; −21.4 (6.6)%; alle P<0.01). N₂LCI_cor und N₂LCI_pre korrelierten mit MRT-Scores bei stabiler CF (r=0.70 bis 0.84; alle P<0.01) ohne signifikanten Unterschied zwischen N₂LCI_cor und N₂LCI_pre. Die Veränderung des LCI vom Ausgangswert zur PEx und von PEx bis nach Therapie nahm von N₂LCI_pre zu N₂LCI_cor ab, aber die Veränderungen blieben signifikant (alle P=0.001).

Diskussion/Schlussfolgerungen Unsere Ergebnisse zeigen, dass der N₂LCI_cor signifikant niedriger ist als der N₂LCI_pre, aber die in der ursprünglichen Studie veröffentlichten Schlüsselergebnisse, die N₂MBW und MRT als komplementäre Methoden für die klinische Überwachung bei Kindern mit CF belegen, bleiben davon unberührt.

^* M.M. and E.S. contributed equally as first authors

Publication History

Article published online:
18 December 2023

© 2023. Thieme. All rights reserved.

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