Inflammatory markers can predict pulmonary exacerbations of cystic fibrosis

Aim: Identifying predictors of pulmonary exacerbations in cystic fibrosis (CF) allows for earlier detection and timely treatment, possibly reducing negative impact. Methods: A prospective longitudinal analysis of children aged 0-7 years in the Australian Respiratory Early Surveillance Team for Cystic Fibrosis (AREST CF) study between 2005 and 2015. Inflammatory markers from routine annual bronchoalveolar lavage fluid (BALF) were examined against pulmonary exacerbations (hospitalisation for intravenous antibiotics) in the 6 months post-BALF. Kaplan-Meier curves were created and Weibull regression was used, adjusting for annually repeated measurements in the same patients. Results were adjusted for known risk factors of exacerbations. Results: 1200 BALF samples were taken from 322 children with a total of 492 person-years follow-up. 226 pulmonary exacerbations were recorded. 20% of children were admitted in the 6 months following BALF and in those the median time to admission was 19 days (interquartile range 9-83 days). The risk for a pulmonary exacerbation was increased if neutrophil elastase was detectable (hazard ratio (HR) 3.76, 95%-CI 2.16-3.95, p Conclusion: BALF inflammatory markers are significant predictors of pulmonary exacerbations in young children with CF.