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Flow adhesion of whole blood to P-selectin: a prognostic biomarker for vaso-occlusive crisis in sickle cell disease.
Hines, Patrick C; Callaghan, Michael U; Zaidi, Ahmar U; Gao, Xiufeng; Liu, Ke; White, Jennell; Tarasev, Michael.
Afiliación
  • Hines PC; Functional Fluidics, Detroit, MI, USA.
  • Callaghan MU; Division of Pediatric Critical Care Medicine, Children's Hospital of Michigan, Detroit, MI, USA.
  • Zaidi AU; Wayne Pediatrics, Detroit, MI, USA.
  • Gao X; Division of Pediatric Hematology and Oncology, Central Michigan University, Detroit, MI, USA.
  • Liu K; Division of Pediatric Hematology and Oncology, Central Michigan University, Detroit, MI, USA.
  • White J; Functional Fluidics, Detroit, MI, USA.
  • Tarasev M; Functional Fluidics, Detroit, MI, USA.
Br J Haematol ; 194(6): 1074-1082, 2021 09.
Article en En | MEDLINE | ID: mdl-34472086
Blood cell adhesion to P-selectin and vascular cell adhesion molecule-1 (VCAM-1) contributes to the pathophysiology of vaso-occlusion crisis (VOC) events in individuals with sickle cell disease (SCD). We evaluated the use of standardized flow adhesion biomarkers in a six-month, 35-subjects longitudinal study (ELIPSIS). Flow adhesion of whole blood on P-selectin (FA-WB-Psel) and VCAM1 (FA-WB-VCAM), and of isolated white blood cells on P-selectin (FA-WBC-Psel) and VCAM-1 (FA-WBC-VCAM) were elevated on VOC days compared with non-VOC days, but only FA-WB-Psel reached statistical significance (P = 0·015). Optimal cut-off values were established with Cox regression models for FA-WB-Psel [46 cells/mm²; hazard ratio (HR): 2·3; 95% confidence interval (CI):1·4-4·0; P = 0·01] and FA-WB-VCAM (408 cells/mm², HR:1·8; 95% CI: 0·9-3·45; P = 0·01). A combined (FA-WB-Psel and FA-WB-VCAM) multimarker risk score was also significantly (P = 0·0006) correlated with VOC risk that was two-fold higher for intermediate and 5·64-fold higher for high score. The concordance (C)-index for the multimarker score was 0·63 in the six-month period (95% CI: 0·56-0·70), indicating a better ability to distinguish patient risk of VOC, compared to individual biomarkers FA-WB-VCAM (C-index: 0·57; 95% CI: 0·49-0·65) or FA-WB-Psel (C-index: 0·58; 95% CI: 0·53-0·62). The presented multimarker score can be used to risk-stratify individuals with SCD during their steady state into low, intermediate, and high-risk strata for self-reported VOCs. Such risk stratification could help focus healthcare resources more efficiently to maintiain health, personalize treatment selection to each patient's individual needs, and potentially reduce healthcare costs.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Selectina-P / Anemia de Células Falciformes Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Female / Humans / Male Idioma: En Revista: Br J Haematol Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Selectina-P / Anemia de Células Falciformes Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Female / Humans / Male Idioma: En Revista: Br J Haematol Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido