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Serum Eosinophilic Cationic Protein Is a Reliable Biomarker for Childhood Asthma
Niclas Rydell1, Mizuho Nagao2, Robert Movérare1,3
1Thermo Fisher Scientific, Uppsala, Sweden.
Insights
Serum eosinophilic cationic protein (ECP) is a reliable biomarker for diagnosing childhood asthma. Combining ECP with FeNO and spirometry significantly improves diagnostic accuracy for current asthma.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Biomarker Discovery
Background:
- Eosinophilic cationic protein (ECP) is linked to airway inflammation and asthma.
- The diagnostic utility of serum ECP in pediatric asthma requires further investigation.
Purpose of the Study:
- To evaluate the diagnostic performance of serum ECP and other asthma biomarkers in children.
- To assess the combined diagnostic value of ECP with fractional exhaled nitric oxide (FeNO) and spirometry.
Main Methods:
- Cross-sectional study involving children aged 5-16 with current asthma (CA), transient asthma (TA), and healthy controls (HC).
- Measured serum ECP, blood eosinophil count (B-Eos), FeNO, and spirometry (FEV1/FVC ratio).
Main Results:
- Serum ECP and B-Eos were significantly elevated in CA and TA compared to HC.
- ECP and B-Eos demonstrated the highest diagnostic performance for CA (AUC 0.801 and 0.810).
- Combining ECP with FeNO and FEV1/FVC ratio significantly increased the odds ratio for diagnosing CA.
Conclusions:
- Serum ECP is a valuable and reliable biomarker for diagnosing childhood asthma.
- ECP offers an alternative to blood eosinophil counts and enhances diagnostic accuracy when combined with FeNO and spirometry.
Background:
Eosinophilic cationic protein (ECP) is associated with airway inflammation and asthma. However, the clinical value of measuring ECP in childhood asthma is not fully known. We aimed to study the diagnostic performance of serum ECP and other common asthma biomarkers, individually and in combinations.
Methods:
In a cross-sectional study, 5-16-year-old children with current asthma (CA) (n = 37), transient asthma (TA) (n = 43), (previous history of wheezing/asthma), and healthy children (HC) (n = 86) were investigated for ECP, blood eosinophil count (B-Eos), fractional exhaled nitric oxide (FeNO), and lung function, i.e., spirometry (forced expiratory volume during the first second [FEV1]/forced vital capacity [FVC] ratio).
Results:
Both ECP and B-Eos were higher in CA compared to TA (p < 0.01) and HC (p < 0.0001). ECP and B-Eos were also higher in TA compared to HC (p < 0.05 and p < 0.001, respectively). FeNO was higher in CA (p < 0.0001) and TA (p < 0.01) compared to HC but similar between the asthma groups. The FEV1/FVC ratio was lower in CA compared to TA and HC (both p < 0.01) but similar between TA and HC. The best diagnostic performance regarding CA was found for ECP and B-Eos with receiver operating characteristics area under curve (AUC) of 0.801 and 0.810, respectively. The optimal cutoff for ECP (29 μg/L) yielded a sensitivity and specificity of 70.3% and 81.4%. The corresponding AUCs for FeNO and FEV1/FVC were 0.732 and 0.670, respectively. ECP and B-Eos showed the highest AUCs (0.669 and 0.673) for differentiation between CA and TA. Combining ECP with FeNO and FEV1/FVC increased the odds ratio (OR) for having CA from OR 3.97-10.3 for the single biomarkers to OR 20.2 (95% confidence interval: 5.76-68.6).
Conclusion:
Our results show that serum ECP is a reliable biomarker in the diagnosis of childhood asthma, with additional value in combination with FeNO and FEV1/FVC, and that ECP can be an alternative to B-Eos.
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