Dataset Information

Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI.

ABSTRACT:

Background

The causative agents for the current national outbreak of electronic-cigarette, or vaping, product use-associated lung injury (EVALI) have not been established. Detection of toxicants in bronchoalveolar-lavage (BAL) fluid from patients with EVALI can provide direct information on exposure within the lung.

Methods

BAL fluids were collected from 51 patients with EVALI in 16 states and from 99 healthy participants who were part of an ongoing study of smoking involving nonsmokers, exclusive users of e-cigarettes or vaping products, and exclusive cigarette smokers that was initiated in 2015. Using the BAL fluid, we performed isotope dilution mass spectrometry to measure several priority toxicants: vitamin E acetate, plant oils, medium-chain triglyceride oil, coconut oil, petroleum distillates, and diluent terpenes.

Results

State and local health departments assigned EVALI case status as confirmed for 25 patients and as probable for 26 patients. Vitamin E acetate was identified in BAL fluid obtained from 48 of 51 case patients (94%) in 16 states but not in such fluid obtained from the healthy comparator group. No other priority toxicants were found in BAL fluid from the case patients or the comparator group, except for coconut oil and limonene, which were found in 1 patient each. Among the case patients for whom laboratory or epidemiologic data were available, 47 of 50 (94%) had detectable tetrahydrocannabinol (THC) or its metabolites in BAL fluid or had reported vaping THC products in the 90 days before the onset of illness. Nicotine or its metabolites were detected in 30 of 47 of the case patients (64%).

Conclusions

Vitamin E acetate was associated with EVALI in a convenience sample of 51 patients in 16 states across the United States. (Funded by the National Cancer Institute and others.).

SUBMITTER: Blount BC

PROVIDER: S-EPMC7032996 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Publications

Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI.

Blount Benjamin C BC Karwowski Mateusz P MP Shields Peter G PG Morel-Espinosa Maria M Valentin-Blasini Liza L Gardner Michael M Braselton Martha M Brosius Christina R CR Caron Kevin T KT Chambers David D Corstvet Joseph J Cowan Elizabeth E De Jesús Víctor R VR Espinosa Paul P Fernandez Carolina C Holder Cory C Kuklenyik Zsuzsanna Z Kusovschi Jennifer D JD Newman Cody C Reis Gregory B GB Rees Jon J Reese Chris C Silva Lalith L Seyler Tiffany T Song Min-Ae MA Sosnoff Connie C Spitzer Carleen R CR Tevis Denise D Wang Lanqing L Watson Cliff C Wewers Mark D MD Xia Baoyun B Heitkemper Douglas T DT Ghinai Isaac I Layden Jennifer J Briss Peter P King Brian A BA Delaney Lisa J LJ Jones Christopher M CM Baldwin Grant T GT Patel Anita A Meaney-Delman Dana D Rose Dale D Krishnasamy Vikram V Barr John R JR Thomas Jerry J Pirkle James L JL

The New England journal of medicine 20191220 8

<h4>Background</h4>The causative agents for the current national outbreak of electronic-cigarette, or vaping, product use-associated lung injury (EVALI) have not been established. Detection of toxicants in bronchoalveolar-lavage (BAL) fluid from patients with EVALI can provide direct information on exposure within the lung.<h4>Methods</h4>BAL fluids were collected from 51 patients with EVALI in 16 states and from 99 healthy participants who were part of an ongoing study of smoking involving nons ...[more]

PMID: 31860793

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Project description:BackgroundThe pathogenesis of invasive aspergillosis (IA) is still unknown, but its progression is rapid and mortality rate remains high. Bronchoalveolar lavage fluid (BALF) galactomannan (GM) analysis has been used to diagnose IA. This study is aimed at making an accurate estimate of the whole accuracy of BALF-GM in diagnosing IA.MethodsAfter a systematic review of the study, a bivariate meta-analysis was used to summarize the specificity (SPE), the sensitivity (SEN), the positive likelihood ratios (PLR), and the negative likelihood ratios (NLR) of BALF-GM in diagnosing IA. The overall test performance was summarized using a layered summary receiver operating characteristic (SROC) curve. Subgroup analysis was performed to explore the heterogeneity between studies.ResultsA total of 65 studies that are in line with the inclusion criteria were included. The summary estimates of BALF-GM analysis are divided into four categories. The first is the proven+probable vs. possible+no IA, with an SPE, 0.87 (95% CI, 0.85-0.98); SEN, 0.81 (95% CI, 0.76-0.84); PLR, 9.78 (5.78-16.56); and NLR, 0.20 (0.14-0.29). The AUC was 0.94. The BALF-GM test for proven+probable vs. no IA showed SPE, 0.88 (95% CI, 0.87-0.90); SEN, 0.82 (95% CI, 0.78-0.85); PLR, 6.56 (4.93-8.75); and NLR, 0.24 (0.17-0.33). The AUC was 0.93. The BALF-GM test for proven+probable+possible vs. no IA showed SPE, 0.82 (95% CI, 0.79-0.95); SEN, 0.59 (95% CI, 0.55-0.63); PLR, 3.60 (2.07-6.25); and NLR, 0.31 (0.15-0.61). The AUC was 0.86. The analyses for others showed SPE, 0.85 (95% CI, 0.83-0.87); SEN, 0.89 (95% CI, 0.86-0.91); PLR, 6.91 (4.67-10.22); and NLR, 0.18 (0.13-0.26). The AUC was 0.94.ConclusionsThe findings of this BALF-GM test resulted in some impact on the diagnosis of IA. The BALF-GM assay is considered a method for diagnosing IA with high SEN and SPE. However, the patients' underlying diseases may affect the accuracy of diagnosis. When the cutoff is greater than 1, the sensitivity will be higher.

Dataset Information

Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI.

Background

Methods

Results

Conclusions

Publications

Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI.

Similar Datasets

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