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Nevejan L, Labarque V, Boeckx N. Chronic myeloid leukemia (CML) in children and adolescents-Clinicopathological findings. Eur J Haematol 2024; 112:458-465. [PMID: 37985225 DOI: 10.1111/ejh.14137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Barely two per million Belgian children/adolescents are diagnosed with chronic myeloid leukemia (CML) annually. In this retrospective study, we aimed to investigate the diagnostic features, clinical and laboratory characteristics, and treatment outcome of this rare entity. METHODS Medical records of all pediatric CML patients (age ≤ 17 years) diagnosed at the University Hospitals Leuven between 1986 and 2021 were reviewed. RESULTS Fourteen patients (median age at diagnosis 12.5 years) were included, all presenting in chronic phase. Five patients were diagnosed before 2003; main therapy included hydroxyurea (n = 5/5), interferon-alfa (n = 3/5) and allogeneic hematopoietic stem cell transplantation (allo-Tx) (n = 3/5). Complete hematologic response (CHR), complete cytogenetic response (CCyR) and major molecular response (MMR) was reached in resp. 4/5, 4/5 and in 2/3 of evaluable patients. Three patients progressed to accelerated/blast phase (median time 19 months) and 1/5 is alive and disease-free at last follow-up. Nine patients were diagnosed after 2003 and were treated with first generation (1°G) tyrosine kinase inhibitors (TKI): 3/9 subsequently underwent an allo-Tx, 4/9 were switched to 2°G TKI, one patient was additionally switched to 3°G TKI. CHR, CCyR and MMR was reached in 9/9, 9/9 and 8/9 of these patients. No progression to accelerated/blast phase was observed and none of these patients deceased. At last follow-up, 7/9 patients were in MMR or disease free, the two remaining patients did not reach or lost MMR, both related to compliance issues. CONCLUSION Our study confirmed that TKI significantly improved the prognosis of pediatric CML. However, drug compliance poses a considerable challenge.
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Affiliation(s)
- Louis Nevejan
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Veerle Labarque
- Department of Paediatrics, Paediatric Haematology and Oncology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium
| | - Nancy Boeckx
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Laboratory of Experimental Hematology, University of Leuven, Leuven, Belgium
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Nevejan L, Strypens T, Van Nieuwenhove M, Boel A, Cattoir L, Van Vaerenbergh K, Meeus P, Bossuyt X, De Neve N, Van Hoovels L. Serial measurement of circulating calprotectin as a prognostic biomarker in COVID-19 patients in intensive care setting. Clin Chem Lab Med 2023; 61:494-502. [PMID: 36473060 DOI: 10.1515/cclm-2022-1165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Circulating calprotectin (cCLP) has been shown to be a promising prognostic marker for COVID-19 severity. We aimed to investigate the prognostic value of serial measurements of cCLP in COVID-19 patients admitted to an intensive care unit (ICU). METHODS From November 2020 to May 2021, patients with COVID-19, admitted at the ICU of the OLV Hospital, Aalst, Belgium, were prospectively included. For sixty-six (66) patients, blood samples were collected at admission and subsequently every 48 h during ICU stay. On every sample (total n=301), a cCLP (EliA™ Calprotectin 2, Phadia 200, Thermo Fisher Scientific; serum/plasma protocol (for Research Use Only, -RUO-) and C-reactive protein (CRP; cobas c501/c503, Roche Diagnostics) analysis were performed. Linear mixed models were used to associate biomarkers levels with mortality, need for mechanical ventilation, length of stay at ICU (LOS-ICU) and medication use (antibiotics, corticosteroids, antiviral and immune suppressant/modulatory drugs). RESULTS Longitudinally higher levels of all biomarkers were associated with LOS-ICU and with the need for mechanical ventilation. Medication use and LOS-ICU were not associated with variations in cCLP and CRP levels. cCLP levels increased significantly during ICU hospitalization in the deceased group (n=21/66) but decreased in the non-deceased group (n=45/66). In contrast, CRP levels decreased non-significantly in both patient groups, although significantly longitudinally higher CRP levels were obtained in the deceased subgroup. CONCLUSIONS Serial measurements of cCLP provides prognostic information which can be useful to guide clinical management of COVID-19 patients in ICU setting.
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Affiliation(s)
- Louis Nevejan
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium.,Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
| | - Thomas Strypens
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium.,Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
| | - Mathias Van Nieuwenhove
- Department of Intensive Care Medicine, OLV Hospital, Aalst, Belgium.,Department of Anesthesiology, OLV Hospital, Aalst, Belgium
| | - An Boel
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
| | - Lien Cattoir
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
| | | | - Peter Meeus
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
| | - Xavier Bossuyt
- Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium.,Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Nikolaas De Neve
- Department of Intensive Care Medicine, OLV Hospital, Aalst, Belgium.,Department of Anesthesiology, OLV Hospital, Aalst, Belgium
| | - Lieve Van Hoovels
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium.,Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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Nevejan L, Ombelet S, Laenen L, Keyaerts E, Demuyser T, Seyler L, Soetens O, Van Nedervelde E, Naesens R, Geysels D, Verstrepen W, Cattoir L, Martens S, Michel C, Mathieu E, Reynders M, Evenepoel A, Hellemans J, Vanhee M, Magerman K, Maes J, Matheeussen V, Boogaerts H, Lagrou K, Cuypers L, André E. Severity of COVID-19 among Hospitalized Patients: Omicron Remains a Severe Threat for Immunocompromised Hosts. Viruses 2022; 14:v14122736. [PMID: 36560741 PMCID: PMC9783877 DOI: 10.3390/v14122736] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
The Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in the general population in the context of a relatively high immunity gained through the early waves of coronavirus disease 19 (COVID-19), and vaccination campaigns. Despite this context, a significant number of patients were hospitalized, and identifying the risk factors associated with severe disease in the Omicron era is critical for targeting further preventive, and curative interventions. We retrospectively analyzed the individual medical records of 1501 SARS-CoV-2 positive hospitalized patients between 13 December 2021, and 13 February 2022, in Belgium, of which 187 (12.5%) were infected with Delta, and 1036 (69.0%) with Omicron. Unvaccinated adults showed an increased risk of moderate/severe/critical/fatal COVID-19 (crude OR 1.54; 95% CI 1.09-2.16) compared to vaccinated patients, whether infected with Omicron or Delta. In adults infected with Omicron and moderate/severe/critical/fatal COVID-19 (n = 323), immunocompromised patients showed an increased risk of in-hospital mortality related to COVID-19 (adjusted OR 2.42; 95% CI 1.39-4.22), compared to non-immunocompromised patients. The upcoming impact of the pandemic will be defined by evolving viral variants, and the immune system status of the population. The observations support that, in the context of an intrinsically less virulent variant, vaccination and underlying patient immunity remain the main drivers of severe disease.
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Affiliation(s)
- Louis Nevejan
- Department of Laboratory Medicine, National Reference Center for Respiratory Pathogens, UZ Leuven—University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Correspondence: (L.N.); (L.C.); (E.A.)
| | - Sien Ombelet
- Department of Laboratory Medicine, National Reference Center for Respiratory Pathogens, UZ Leuven—University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, 3000 Leuven, Belgium
| | - Lies Laenen
- Department of Laboratory Medicine, National Reference Center for Respiratory Pathogens, UZ Leuven—University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, 3000 Leuven, Belgium
| | - Els Keyaerts
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, 3000 Leuven, Belgium
| | - Thomas Demuyser
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), UZ Brussel—University Hospitals Brussels, 1090 Brussels, Belgium
- Center for Neurosciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Lucie Seyler
- Department of Internal Medicine and Infectious Diseases, Vrije Universiteit Brussel (VUB), UZ Brussel—University Hospitals Brussels, 1090 Brussels, Belgium
| | - Oriane Soetens
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), UZ Brussel—University Hospitals Brussels, 1090 Brussels, Belgium
| | - Els Van Nedervelde
- Department of Internal Medicine and Infectious Diseases, Vrije Universiteit Brussel (VUB), UZ Brussel—University Hospitals Brussels, 1090 Brussels, Belgium
| | - Reinout Naesens
- Department of Medical Microbiology, Department of infection prevention and control, ZNA Middelheim, 2020 Antwerp, Belgium
| | - Dieter Geysels
- Department of Medical Microbiology, Department of infection prevention and control, ZNA Middelheim, 2020 Antwerp, Belgium
| | - Walter Verstrepen
- Department of Medical Microbiology, Department of infection prevention and control, ZNA Middelheim, 2020 Antwerp, Belgium
| | - Lien Cattoir
- Clinical Laboratory of Microbiology, OLV Hospital, 9300 Aalst, Belgium
| | - Steven Martens
- Clinical Laboratory of Microbiology, OLV Hospital, 9300 Aalst, Belgium
| | - Charlotte Michel
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles, Université Libre de Bruxelles, 1000 Brussels, Belgium
| | - Elise Mathieu
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles, Université Libre de Bruxelles, 1000 Brussels, Belgium
| | - Marijke Reynders
- Department of Laboratory Medicine—Medical Microbiology, AZ Sint Jan Brugge-Oostende, 8000 Brugge, Belgium
| | - Anton Evenepoel
- Department of Laboratory Medicine—Medical Microbiology, AZ Sint Jan Brugge-Oostende, 8000 Brugge, Belgium
| | - Jorn Hellemans
- Department of Laboratory Medicine—Medical Microbiology, AZ Sint Jan Brugge-Oostende, 8000 Brugge, Belgium
| | - Merijn Vanhee
- Department of Laboratory Medicine—Medical Microbiology, AZ Sint Jan Brugge-Oostende, 8000 Brugge, Belgium
| | - Koen Magerman
- Clinical Laboratory, Jessa Hospital, 3500 Hasselt, Belgium
| | - Justine Maes
- Clinical Laboratory, Jessa Hospital, 3500 Hasselt, Belgium
| | - Veerle Matheeussen
- Department of Microbiology, University Hospital Antwerp, 2650 Antwerp, Belgium
| | - Hélène Boogaerts
- Department of Microbiology, University Hospital Antwerp, 2650 Antwerp, Belgium
| | - Katrien Lagrou
- Department of Laboratory Medicine, National Reference Center for Respiratory Pathogens, UZ Leuven—University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, 3000 Leuven, Belgium
| | - Lize Cuypers
- Department of Laboratory Medicine, National Reference Center for Respiratory Pathogens, UZ Leuven—University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, 3000 Leuven, Belgium
- Correspondence: (L.N.); (L.C.); (E.A.)
| | - Emmanuel André
- Department of Laboratory Medicine, National Reference Center for Respiratory Pathogens, UZ Leuven—University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, 3000 Leuven, Belgium
- Correspondence: (L.N.); (L.C.); (E.A.)
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Nevejan L, Cuypers L, Laenen L, Van Loo L, Vermeulen F, Wollants E, Van Hecke I, Desmet S, Lagrou K, Maes P, André E. Early SARS-CoV-2 Reinfections within 60 Days and Implications for Retesting Policies. Emerg Infect Dis 2022; 28:1729-1731. [PMID: 35738346 PMCID: PMC9328893 DOI: 10.3201/eid2808.220617] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Illustrated by a clinical case supplemented by epidemiologic data, early reinfections with SARS-CoV-2 Omicron BA.1 after infection with Delta variant, and reinfection with Omicron BA.2 after Omicron BA.1 infection, can occur within 60 days, especially in young, unvaccinated persons. The case definition of reinfection, which influences retesting policies, should be reconsidered.
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Van Hoovels L, Vercammen M, Nevejan L, Cornette M, Briers PJ, Deeren D, Van Droogenbroeck J, Fostier K, De Smet D. Serum free light chain analysis: persisting limitations with new kids on the block. Clin Chem Lab Med 2022; 60:1440-1448. [PMID: 35781357 DOI: 10.1515/cclm-2022-0347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/21/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Serum free light chain (sFLC) measurements have inherent analytical limitations impacting sFLC clinical interpretation. We evaluated analytical and diagnostic performance of three polyclonal sFLC assays on four analytical platforms. METHODS sFLC concentration was measured using Diazyme FLC assays (Diazyme) on cobas c501/c503 analyzer (Roche); Freelite assays (The Binding Site) on Optilite analyzer (The Binding Site) and cobas c501 analyzer and Sebia FLC ELISA assays (Sebia) on AP22 ELITE analyzer (DAS). Imprecision, linearity, method comparison vs. Freelite/Optilite, antigen excess detection and reference value verification were assessed. Diagnostic performance was compared on 120 serum samples and on follow-up samples of five patients with κ and λ monoclonal gammopathy. RESULTS Method comparison showed excellent correlation with Freelite/Optilite method for all assays. A large proportional negative bias was shown for both Sebia κ and λ ELISA and a significant positive proportional bias for λ in the low (<10 mg/L) Freelite/cobas c501 method. Clinically relevant underestimation of κ sFLC levels due to antigen excess was shown for 7% of each Diazyme/cobas application and for 11 and 32.1% of λ sFLC assay of respectively Diazyme/cobas and Sebia/AP22. sFLC reference values revealed application specific. Cohen's κ values were (very) good for κ sFLC but only moderate to good for λ sFLC. In 4/10 follow-up patients, significant differences in clinical interpretation between sFLC assays were noticed. CONCLUSIONS Important analytical limitations remain for all sFLC applications. Differences in reference values and diagnostic performance hamper interchangeability of sFLC assays. Assay specific sFLC decision guidelines are warranted.
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Affiliation(s)
- Lieve Van Hoovels
- Department of Laboratory Medicine, OLV Hospital Aalst, Aalst, Belgium.,Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Martine Vercammen
- Department of Laboratory Medicine, AZ Sint-Jan Hospital Brugge - Oostende AV, Bruges, Belgium.,Research group REIM, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Louis Nevejan
- Department of Laboratory Medicine, OLV Hospital Aalst, Aalst, Belgium.,Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
| | - Margot Cornette
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium.,Department of Laboratory Medicine, University Hospital Ghent, Ghent, Belgium
| | - Pieter-Jan Briers
- Department of Laboratory Medicine, AZ Sint-Jan Hospital Brugge - Oostende AV, Bruges, Belgium.,Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
| | - Dries Deeren
- Department of Hematology, AZ Delta Hospital, Roeselare, Belgium
| | - Jan Van Droogenbroeck
- Department of Hematology, AZ Sint-Jan Hospital Brugge - Oostende AV, Bruges, Belgium
| | - Karel Fostier
- Department of Hematology, OLV Hospital, Aalst, Belgium
| | - Dieter De Smet
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium
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Van Goethem N, Chung PYJ, Meurisse M, Vandromme M, De Mot L, Brondeel R, Stouten V, Klamer S, Cuypers L, Braeye T, Catteau L, Nevejan L, van Loenhout JAF, Blot K. Clinical Severity of SARS-CoV-2 Omicron Variant Compared with Delta among Hospitalized COVID-19 Patients in Belgium during Autumn and Winter Season 2021-2022. Viruses 2022; 14:1297. [PMID: 35746768 PMCID: PMC9227815 DOI: 10.3390/v14061297] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 01/08/2023] Open
Abstract
This retrospective multi-center matched cohort study assessed the risk for severe COVID-19 (combination of severity indicators), intensive care unit (ICU) admission, and in-hospital mortality in hospitalized patients when infected with the Omicron variant compared to when infected with the Delta variant. The study is based on a causal framework using individually-linked data from national COVID-19 registries. The study population consisted of 954 COVID-19 patients (of which, 445 were infected with Omicron) above 18 years old admitted to a Belgian hospital during the autumn and winter season 2021-2022, and with available viral genomic data. Patients were matched based on the hospital, whereas other possible confounders (demographics, comorbidities, vaccination status, socio-economic status, and ICU occupancy) were adjusted for by using a multivariable logistic regression analysis. The estimated standardized risk for severe COVID-19 and ICU admission in hospitalized patients was significantly lower (RR = 0.63; 95% CI (0.30; 0.97) and RR = 0.56; 95% CI (0.14; 0.99), respectively) when infected with the Omicron variant, whereas in-hospital mortality was not significantly different according to the SARS-CoV-2 variant (RR = 0.78, 95% CI (0.28-1.29)). This study demonstrates the added value of integrated genomic and clinical surveillance to recognize the multifactorial nature of COVID-19 pathogenesis.
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Affiliation(s)
- Nina Van Goethem
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Pui Yan Jenny Chung
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Marjan Meurisse
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Mathil Vandromme
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Laurane De Mot
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Ruben Brondeel
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Veerle Stouten
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Sofieke Klamer
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Lize Cuypers
- Clinical Department of Laboratory Medicine and National Reference Center for Respiratory Pathogens, University Hospitals Leuven, 3000 Leuven, Belgium; (L.C.); (L.N.)
| | - Toon Braeye
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Lucy Catteau
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Louis Nevejan
- Clinical Department of Laboratory Medicine and National Reference Center for Respiratory Pathogens, University Hospitals Leuven, 3000 Leuven, Belgium; (L.C.); (L.N.)
| | - Joris A. F. van Loenhout
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
| | - Koen Blot
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium; (P.Y.J.C.); (M.M.); (M.V.); (L.D.M.); (R.B.); (V.S.); (S.K.); (T.B.); (L.C.); (J.A.F.v.L.); (K.B.)
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Nevejan L, Strypens T, Van Nieuwenhove M, Boel A, Cattoir L, Meeus P, Bossuyt X, De Neve N, Van Hoovels L. Prognostic value of circulating calprotectin levels on the clinical course of COVID-19 differs between serum, heparin, EDTA and citrate sample types. Clin Chim Acta 2022; 525:54-61. [PMID: 34919937 PMCID: PMC8669946 DOI: 10.1016/j.cca.2021.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION During the recent SARS-CoV-2 pandemic, circulating calprotectin (cCLP) gained interest as biomarker to predict the severity of COVID-19. We aimed to investigate the prognostic value of cCLP measured in serum, heparin, EDTA and citrate plasma. MATERIALS AND METHODS COVID-19 patients were prospectively included, in parallel with two SARS-CoV-2 negative control populations. The prognostic value of cCLP was compared with IL-6, CRP, LDH, procalcitonin, and the 4C-mortality score by AUROC analysis. RESULTS For the 136 COVID-19 patients, cCLP levels were higher compared to the respective control populations, with significantly higher cCLP levels in serum and heparin than in EDTA or citrate. Higher cCLP levels were obtained for COVID-19 patients with i) severe/critical illness (n = 70), ii) ICU admission (n = 66) and iii) need for mechanical ventilation/ECMO (n = 25), but iv) not in patients who deceased within 30 days (n = 41). The highest discriminatory power (AUC [95% CI]) for each defined outcome was i) CRP (0.835 [0.755-0.914]); ii) EDTA cCLP (0.780 [0.688-0.873]); iii) EDTA cCLP (0.842 [0.758-0.925]) and iv) the 4C-mortality score (0.713 [0.608-0.818]). CONCLUSION Measuring cCLP in COVID-19 patients helps the clinician to predict the clinical course of COVID-19. The discriminatory power of EDTA and citrate plasma cCLP levels often outperforms heparin plasma cCLP levels.
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Affiliation(s)
- Louis Nevejan
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium,Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
| | - Thomas Strypens
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium,Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
| | - Mathias Van Nieuwenhove
- Department of Intensive Care Medicine, OLV Hospital, Aalst, Belgium,Department of Anesthesiology, OLV Hospital, Aalst, Belgium
| | - An Boel
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
| | - Lien Cattoir
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
| | - Peter Meeus
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
| | - Xavier Bossuyt
- Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium,Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Nikolaas De Neve
- Department of Intensive Care Medicine, OLV Hospital, Aalst, Belgium,Department of Anesthesiology, OLV Hospital, Aalst, Belgium
| | - Lieve Van Hoovels
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium,Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium,Corresponding author at: Lieve Van Hoovels, Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
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8
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Nevejan L, Dobbels P, Norman GL, Voreck A, Bossuyt X, Van Hoovels L. Necessity of harmonization of tissue transglutaminase IgA assays to align clinical decision making in coeliac disease. Clin Chem Lab Med 2021; 60:81-84. [PMID: 34890173 DOI: 10.1515/cclm-2021-1207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/03/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Louis Nevejan
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium.,Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
| | - Pieter Dobbels
- Department of Gastroenterology, OLV Hospital, Aalst, Belgium
| | - Gary L Norman
- Headquarters & Technology Center Autoimmunity, Werfen, San Diego, CA, USA
| | | | - Xavier Bossuyt
- Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium.,Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Lieve Van Hoovels
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium.,Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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9
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Nevejan L, Mylemans M, Vander Cruyssen B, Stubbe M, Van Den Bremt S, Hofman L, Infantino M, Manfredi M, Bossuyt X, Van Hoovels L. Pre-analytical recommendations and reference values for circulating calprotectin are sample type and assay dependent. Clin Chem Lab Med 2021; 60:e57-e60. [PMID: 34714981 DOI: 10.1515/cclm-2021-0998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/19/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Louis Nevejan
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium.,Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
| | - Marnix Mylemans
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium.,Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
| | | | - Muriel Stubbe
- Department of Rheumatology, OLV Hospital, Aalst, Belgium
| | | | - Laura Hofman
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
| | - Maria Infantino
- Immunology and Allergy Laboratory Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Mariangela Manfredi
- Immunology and Allergy Laboratory Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Xavier Bossuyt
- Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium.,Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Lieve Van Hoovels
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium.,Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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10
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Mylemans M, Van Honacker E, Nevejan L, Van Den Bremt S, Hofman L, Poels J, Cattoir L, Boel A, Van Hoovels L. Diagnostic and analytical performance evaluation of ten commercial assays for detecting SARS-CoV-2 humoral immune response. J Immunol Methods 2021; 493:113043. [PMID: 33773989 PMCID: PMC7989098 DOI: 10.1016/j.jim.2021.113043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Analytical validation of newly released SARS-CoV-2 antibody assays in the clinical laboratory is crucial to ensure sufficient performance in respect to its intended use. We aimed to assess analytical and diagnostic performance of 8 (semi-)quantitative assays detecting anti-nucleocapsid IgG (Euroimmun, Id-Vet) or total Ig (Roche), anti-spike protein IgG (Euroimmun, Theradiag, DiaSorin, Thermo Fisher) or both (Theradiag) and 2 rapid lateral flow assays (LFA) (AAZ-LMB and Theradiag). METHODS Specificity was evaluated using a cross-reactivity panel of 85 pre-pandemic serum samples. Sensitivity was determined at both the manufacturer's and a 95% specificity cut-off level, using 81 serum samples of patients with a positive rRT-PCR. Sensitivity was determined in function of time post symptoms onset. RESULTS Specificity for all assays ranged from 92.9% to 100% (Roche and Thermo Fisher) with the exception of the Theradiag IgM LFA (82.4%). Sensitivity in asymptomatic patients ranged between 41.7% and 58.3%. Sensitivity on samples taken <10 days since symptom onset was low (23.3%-66.7%) and increased on samples taken between 10 and 20 days and > 20 days since symptom onset (80%-96% and 92.9%-100%, respectively). From 20 days after symptom onset, the Roche, Id-vet and Thermo Fisher assays all met the sensitivity (>95%) and specificity (>97%) targets determined by the WHO. Antibody signal response was significantly higher in the critically ill patient group. CONCLUSION Antibody detection can complement rRT-PCR for the diagnosis of COVID-19, especially in the later stage, or in asymptomatic patients for epidemiological purposes. Addition of IgM in LFAs did not improve sensitivity.
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Affiliation(s)
- Marnix Mylemans
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium,Department of Laboratory Medicine, UZ Leuven, Leuven, Belgium
| | | | - Louis Nevejan
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium,Department of Laboratory Medicine, UZ Leuven, Leuven, Belgium
| | | | - Laura Hofman
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
| | - Jeroen Poels
- Federal Agency for Medicines and Health Products, Brussels, Belgium
| | - Lien Cattoir
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
| | - An Boel
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
| | - Lieve Van Hoovels
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium,Corresponding author at: Department of Laboratory Medicine, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
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11
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Nevejan L, Goegebuer T, Mast P, Lemmens A. Pyelonephritis and bacteremia caused by Haemophilus parainfluenzae: case-report of an unusual pathogen. Acta Clin Belg 2021; 76:152-154. [PMID: 31545159 DOI: 10.1080/17843286.2019.1671059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We present a case of a young man with known urinary tract abnormalities who developed pyelonephritis and bacteremia caused by Haemophilus parainfluenzae. Since routine urine culture usually does not include enriched media for Haemophilus spp., the true incidence of urinary tract infections caused by H. parainfluenzae is currently unknown. Our case, however, demonstrates that H. parainfluenzae is a potential urinary pathogen, at least in patients with urinary tract anomalies. Clinical laboratories should consider expanding their culture efforts to detect unusual pathogens in patients with underlying risk factors.
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Affiliation(s)
- Louis Nevejan
- Department of Clinical Microbiology, AZ Sint-Maarten, Mechelen, Belgium
| | - Truus Goegebuer
- Department of Clinical Microbiology, AZ Sint-Maarten, Mechelen, Belgium
| | - Philippe Mast
- Department of Urology, AZ Sint-Maarten, Mechelen, Belgium
| | - Ann Lemmens
- Department of Clinical Microbiology, AZ Sint-Maarten, Mechelen, Belgium
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12
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Mylemans M, Nevejan L, Van Den Bremt S, Stubbe M, Cruyssen BV, Moulakakis C, Berthold H, Konrad C, Bossuyt X, Van Hoovels L. Circulating calprotectin as biomarker in neutrophil-related inflammation: Pre-analytical recommendations and reference values according to sample type. Clin Chim Acta 2021; 517:149-155. [PMID: 33689693 DOI: 10.1016/j.cca.2021.02.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Calprotectin (CLP) is a promising biomarker for the evaluation of neutrophil-related inflammation. Our aim was to establish reference values for circulating CLP in different sample types and to study the effect of pre-analytical variables. METHODS Reference values were determined in 100 healthy individuals. Pre-analytical variables were evaluated in 10 healthy controls and four rheumatoid arthritis patients with active disease and covered sample type (serum with/without gel separator, heparin, EDTA and citrate plasma), pre-centrifugation time (<2 h, 6 h, 24 h), storage condition (2-8 °C, 18-25 °C, 30 °C) and storage time (24 h, 72 h, 7 days). CLP measurements were performed with the EliA™Calprotectin 2 assay on Phadia™200 (Thermo Fisher Scientific). RESULTS In healthy controls, baseline CLP concentrations in serum were more than double the concentration in EDTA and citrate plasma (0.909 µg/mL versus 0.259 µg/mL and 0.261 µg/mL respectively). Heparin, EDTA and citrate stabilized CLP concentrations for up to 6 h before centrifugation, whereas significant increases in CLP levels were observed when serum was left untreated during that time period. CONCLUSION Clinical studies on circulating CLP need to apply sample type-specific reference values and decision limits. To obtain reproducible CLP results in serum, more stringent pre-analytical sample handling instructions are needed.
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Affiliation(s)
- Marnix Mylemans
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
| | - Louis Nevejan
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
| | | | - Muriel Stubbe
- Department of Rheumatology, OLV Hospital, Aalst, Belgium
| | | | | | | | | | - Xavier Bossuyt
- Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium; Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Lieve Van Hoovels
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium; Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
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13
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Wouters Y, Nevejan L, Louwagie A, Devos H, Dewaele B, Selleslag D, Michaux L. Efficacy of ruxolitinib in B-lymphoblastic leukaemia with the PCM1-JAK2 fusion gene. Br J Haematol 2021; 192:e112-e115. [PMID: 33502001 DOI: 10.1111/bjh.17340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/29/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Yannick Wouters
- Department of Laboratory Medicine, Sint-Franciscus Hospital, Heusden-Zolder, Belgium.,Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Louis Nevejan
- Department of Laboratory Medicine, AZ Sint-Jan Hospital Brugge-Oostende, Bruges, Belgium
| | - Annelies Louwagie
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Helena Devos
- Department of Laboratory Medicine, AZ Sint-Jan Hospital Brugge-Oostende, Bruges, Belgium
| | - Barbara Dewaele
- Center for Human Genetics, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Dominik Selleslag
- Department of Hematology, AZ Sint-Jan Hospital Brugge-Oostende, Bruges, Belgium
| | - Lucienne Michaux
- Center for Human Genetics, University Hospitals Leuven and KU Leuven, Leuven, Belgium
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