Document Detail


Refining the value of secretory phospholipase A2 as a predictor of acute chest syndrome in sickle cell disease: results of a feasibility study (PROACTIVE).
MedLine Citation:
PMID:  22463614     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Acute chest syndrome (ACS) is defined as fever, respiratory symptoms and a new pulmonary infiltrate in an individual with sickle cell disease (SCD). Nearly half of ACS episodes occur in SCD patients already hospitalized, potentially permitting pre-emptive therapy in high-risk patients. Simple transfusion of red blood cells may abort ACS if given to patients hospitalized for pain who develop fever and elevated levels of secretory phospholipase A2 (sPLA2). In a feasibility study (PROACTIVE; ClinicalTrials.gov NCT00951808), patients hospitalized for pain who developed fever and elevated sPLA2 were eligible for randomization to transfusion or observation; all others were enrolled in an observational arm. Of 237 enrolled, only 10 were randomized; one of the four to receive transfusion had delayed treatment. Of 233 subjects receiving standard care, 22 developed ACS. A threshold level of sPLA2 ≥ 48 ng/ml gave optimal sensitivity (73%), specificity (71%) and accuracy (71%), but a positive predictive value of only 24%. The predictive value of sPLA2 was improved in adults and patients with chest or back pain, lower haemoglobin concentration and higher white blood cell counts, and in those receiving less than two-thirds maintenance fluids. The hurdles identified in PROACTIVE should facilitate design of a larger, definitive, phase 3 randomized controlled trial.
Authors:
Lori Styles; Carrie G Wager; Richard J Labotka; Kim Smith-Whitley; Alexis A Thompson; Peter A Lane; Lillian E C McMahon; Robin Miller; Susan D Roseff; Rathi V Iyer; Lewis L Hsu; Oswaldo L Castro; Kenneth I Ataga; Onyinye Onyekwere; Maureen Okam; Rita Bellevue; Scott T Miller;
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-03-30
Journal Detail:
Title:  British journal of haematology     Volume:  157     ISSN:  1365-2141     ISO Abbreviation:  Br. J. Haematol.     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-05-10     Completed Date:  2012-07-09     Revised Date:  2014-09-15    
Medline Journal Info:
Nlm Unique ID:  0372544     Medline TA:  Br J Haematol     Country:  England    
Other Details:
Languages:  eng     Pagination:  627-36     Citation Subset:  IM    
Copyright Information:
© 2012 Blackwell Publishing Ltd.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00951808
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MeSH Terms
Descriptor/Qualifier:
Acute Chest Syndrome / blood,  diagnosis*,  etiology*
Adolescent
Adult
Anemia, Sickle Cell / blood,  complications*,  diagnosis
Child
Feasibility Studies
Female
Humans
Male
Phospholipases A2, Secretory / blood*
Prognosis
Young Adult
Grant Support
ID/Acronym/Agency:
MO1-RR02172/RR/NCRR NIH HHS; U10 HL083721/HL/NHLBI NIH HHS; U10 HL083721/HL/NHLBI NIH HHS; U10 HL083721-01/HL/NHLBI NIH HHS; U10HL083721/HL/NHLBI NIH HHS; U54 RR026076/RR/NCRR NIH HHS; UL1-RR-024134/RR/NCRR NIH HHS; UL1RR025747/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
EC 3.1.1.4/Phospholipases A2, Secretory
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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