Comparison of different sets of immunological tests to identify treatable immunodeficiencies in adult bronchiectasis patients
- Stefano Aliberti1,2,9⇑,
- Francesco Amati1,9,
- Andrea Gramegna1,2,
- Barbara Vigone3,
- Martina Oriano1,2,
- Giovanni Sotgiu4,
- Marco Mantero1,2,
- Edoardo Simonetta1,2,
- Laura Saderi4,
- Anna Stainer5,
- Serena Tammaro1,
- Paola Marchisio2,6,
- Eva Polverino7,
- James D. Chalmers8 and
- Francesco Blasi1,2
- 1Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
- 2Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- 3Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
- 4Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
- 5Respiratory Unit, Department of Medicine and Surgery, San Gerardo Hospital, University of Milan-Bicocca, Milan, Italy
- 6Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- 7Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- 8College of Medicine, University of Dundee, Dundee, UK
- 9Shared first authorship
- Stefano Aliberti (stefano.aliberti{at}unimi.it)
Abstract
Background Reported prevalence of immunodeficiencies in bronchiectasis patients is variable depending on the frequency and extent of immunological tests performed. ERS Guidelines recommend a minimum bundle of tests. Broadening the spectrum of immunological tests could increase the number of patients diagnosed with an immunodeficiency and those who could receive specific therapy. The primary objective of the present study was to assess the performance of different sets of immunological tests in diagnosing any, primary, secondary, or treatable immunodeficiencies in adults with bronchiectasis.
Methods An observational, cross-sectional study was conducted at the Bronchiectasis Program of the Policlinico University Hospital in Milan, Italy, from September 2016 to June 2019. Adult outpatients with a clinical and radiological diagnosis of bronchiectasis underwent the same immunological screening during the first visit when clinically stable consisting of: complete blood count, IgA, IgG, IgM, IgG subclasses, total IgE, lymphocyte subsets, and HIV antibodies. The primary endpoint was the prevalence of patients with any immunodeficiencies using five different sets of immunological tests.
Results A total of 401 bronchiectasis patients underwent the immunological screening. A significantly different prevalence of bronchiectasis patients diagnosed with any, primary, or secondary immunodeficiencies was found across different bundles. 44.6% bronchiectasis patients had a diagnosis of immunodeficiency using when IgG subclasses and lymphocyte subset are added to the minimum bundle suggested by the guidelines.
Conclusion A 4-fold increase in the diagnosis of immunodeficiencies can be found in adults with bronchiectasis when IgG subclasses and lymphocyte subsets are added to the bundle of tests recommended by guidelines.
Footnotes
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Conflict of interest: Stefano Aliberti reports grants or contracts from INSMED Incorporated, CHIESI, Fisher & Paykel, outside the submitted work. Royalties or licenses from McGRAW HILL, outside the submitted work. Consulting fees from INSMED Incorporated, INSMED Italy, INSMED Ireland Ltd, ZAMBON, AstraZeneca UK Limited, CSL Behring GmbH, Grifols, Fondazione Charta, Boehringer Ingelheim, CHIESI, ZCUBE Srl, and MENARINI, outside the submitted work. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from GlaxoSmithKline Spa, outside the submitted work. Participation on a Data Safety Monitoring Board or Advisory Board for INSMED Incorporated, INSMED Italy, and AstraZeneca UK Limited, outside the submitted work.
Conflict of interest: Francesco Amati has nothing to disclose.
Conflict of interest: Andrea Gramegna has nothing to disclose.
Conflict of interest: Barbara Vigone has nothing to disclose.
Conflict of interest: Martina Oriano has nothing to disclose.
Conflict of interest: Giovanni Sotgiu has nothing to disclose.
Conflict of interest: Marco Mantero has nothing to disclose.
Conflict of interest: Edoardo Simonetta has nothing to disclose.
Conflict of interest: Laura Saderi has nothing to disclose.
Conflict of interest: Anna Stainer has nothing to disclose.
Conflict of interest: Serena Tammaro has nothing to disclose.
Conflict of interest: Paola Marchisio has nothing to disclose.
Conflict of interest: Eva Polverino
Conflict of interest: James Chalmers reports grants and personal fees from AstraZeneca, grants and personal fees from Boehringer Ingelheim, personal fees from Chiesi, grants and personal fees from GlaxoSmithKline, grants from Gilead Sciences, grants and personal fees from Insmed, personal fees from Novartis, personal fees from Zambon, outside the submitted work.
Conflict of interest: Francesco Blasi reports grants and personal fees from AstraZeneca, Chiesi, GSK, Pfizer and Insmed, outside the submitted work. Personal fees from Guidotti, Grifols, Mundipharma, Novarts and Zambon, outside the submitted work. Grants from Pfizer, outside the submitted work.
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- Received June 10, 2021.
- Accepted September 27, 2021.
- Copyright ©The authors 2021
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