Paediatric perioperative hypersensitivity: the performance of the current consensus formula and the effect of uneventful anaesthesia on serum tryptase
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Paediatric perioperative hypersensitivity : the performance of the current consensus formula and the effect of uneventful anaesthesia on serum tryptase. / Vlaeminck, Nils; Poorten, Marie Line van der; Nygaard Madsen, Cecilie; Bech Melchiors, Birgitte; Michel, Moïse; Gonzalez, Constance; Schrijvers, Rik; Elst, Jessy; Mertens, Christel; Saldien, Vera; Vitte, Joana; Garvey, Lene H.; Sabato, Vito; Ebo, Didier G.
In: BJA Open, Vol. 9, 100254, 2024.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Paediatric perioperative hypersensitivity
T2 - the performance of the current consensus formula and the effect of uneventful anaesthesia on serum tryptase
AU - Vlaeminck, Nils
AU - Poorten, Marie Line van der
AU - Nygaard Madsen, Cecilie
AU - Bech Melchiors, Birgitte
AU - Michel, Moïse
AU - Gonzalez, Constance
AU - Schrijvers, Rik
AU - Elst, Jessy
AU - Mertens, Christel
AU - Saldien, Vera
AU - Vitte, Joana
AU - Garvey, Lene H.
AU - Sabato, Vito
AU - Ebo, Didier G.
N1 - Publisher Copyright: © 2023 The Authors
PY - 2024
Y1 - 2024
N2 - Background: Paired sampling of acute (aST) and basal (bST) serum tryptase has been recommended when investigating patients with a suspected perioperative hypersensitivity (POH) reaction. In the current consensus formula, an aST value exceeding (1.2×bST+2) confirms mast cell activation. The current consensus formula has been validated in adults but not in children. Methods: We prospectively included 96 children who underwent uneventful anaesthesia and sampled serum tryptase at baseline and 60–90 min after induction. Tryptase changes were then compared with those in 94 children with suspected POH who were retrospectively included from four reference centres in Belgium, France, and Denmark. Results: We observed a median decrease in serum tryptase during uneventful anaesthesia of 0.41 μg L−1 (–15.9%; P<0.001). The current consensus formula identified mast cell activation in 31.9% of paediatric POH patients. After generating receiver operating characteristic curves through 100 repeated five-fold cross-validation, aST>bST+0.71 was identified as the optimal cut-off point to identify mast cell activation. This new paediatric formula has higher sensitivity than the current consensus formula (53.2% vs 31.9%, P<0.001) with a specificity of 96.9%. Analysis in the subpopulation where a culprit was identified and in grade 3–4 reactions similarly yielded higher sensitivity for the new paediatric formula when compared with the current consensus formula (85.3% vs 61.8%; P=0.008 and 78.0% vs 48.8%; P<0.001, respectively). Internally cross-validated sensitivity and specificity were 53.3% and 93.3%, respectively. Conclusions: This is the first study suggesting the need for an adjusted formula in children to identify perioperative mast cell activation as tryptase is significantly lowered during uneventful anaesthesia. We propose a new formula (aST>bST+0.71) which performs significantly better than the current consensus formula in our multicentric paediatric population.
AB - Background: Paired sampling of acute (aST) and basal (bST) serum tryptase has been recommended when investigating patients with a suspected perioperative hypersensitivity (POH) reaction. In the current consensus formula, an aST value exceeding (1.2×bST+2) confirms mast cell activation. The current consensus formula has been validated in adults but not in children. Methods: We prospectively included 96 children who underwent uneventful anaesthesia and sampled serum tryptase at baseline and 60–90 min after induction. Tryptase changes were then compared with those in 94 children with suspected POH who were retrospectively included from four reference centres in Belgium, France, and Denmark. Results: We observed a median decrease in serum tryptase during uneventful anaesthesia of 0.41 μg L−1 (–15.9%; P<0.001). The current consensus formula identified mast cell activation in 31.9% of paediatric POH patients. After generating receiver operating characteristic curves through 100 repeated five-fold cross-validation, aST>bST+0.71 was identified as the optimal cut-off point to identify mast cell activation. This new paediatric formula has higher sensitivity than the current consensus formula (53.2% vs 31.9%, P<0.001) with a specificity of 96.9%. Analysis in the subpopulation where a culprit was identified and in grade 3–4 reactions similarly yielded higher sensitivity for the new paediatric formula when compared with the current consensus formula (85.3% vs 61.8%; P=0.008 and 78.0% vs 48.8%; P<0.001, respectively). Internally cross-validated sensitivity and specificity were 53.3% and 93.3%, respectively. Conclusions: This is the first study suggesting the need for an adjusted formula in children to identify perioperative mast cell activation as tryptase is significantly lowered during uneventful anaesthesia. We propose a new formula (aST>bST+0.71) which performs significantly better than the current consensus formula in our multicentric paediatric population.
KW - Formula for mast cell activation in children
KW - Paediatric POH
KW - Paired serum tryptase
KW - Performance of consensus formula
KW - Perioperative anaphylaxis
KW - Perioperative hypersensitivity
KW - POH diagnosis
KW - Uneventful anaesthesia
U2 - 10.1016/j.bjao.2023.100254
DO - 10.1016/j.bjao.2023.100254
M3 - Journal article
C2 - 38261931
AN - SCOPUS:85182801985
VL - 9
JO - BJA Open
JF - BJA Open
SN - 2772-6096
M1 - 100254
ER -
ID: 381064762