PDF(Pubmed)
Abstract：
UNASSIGNED: Myocarditis is a dreaded and unpredictable complication of immune checkpoint inhibitors (ICI). We sought to determine whether routinely measured biomarkers could be helpful in monitoring for ICI myocarditis.
UNASSIGNED: The authors examined biomarker trends of patients on ICI and their association with the incidence of ICI myocarditis and outcomes.
UNASSIGNED: We conducted an observational cohort study of adults who received at least one dose of ICI at Michigan Medicine between June 2014 and December 2021 and underwent systematic serial testing for aspartate aminotransferase (AST) and alanine aminotransferase (ALT), creatine phosphokinase (CPK), and lactate dehydrogenase during ICI therapy.
UNASSIGNED: Among 2,606 patients (mean age 64 ± 13 years; 60.7% men), 27 (1.0%) were diagnosed with ICI myocarditis. At diagnosis, patients with myocarditis had an elevated high-sensitivity troponin T (100%), ALT (88.9%), AST (85.2%), CPK (88.9%), and lactate dehydrogenase (92.6%). Findings were confirmed in an independent cohort of 30 patients with biopsy-confirmed ICI myocarditis. A total of 95% of patients with ICI myocarditis had elevations in at least 3 biomarkers compared with 5% of patients without myocarditis. Among the noncardiac biomarkers, only CPK was associated (per 100% increase) with the development of myocarditis (HR: 1.83; 95% CI: 1.59-2.10) and all-cause mortality (HR: 1.10; 95% CI: 1.01-1.20) in multivariable analysis. Elevations in CPK had a sensitivity of 99% and specificity of 23% for identifying myocarditis.
UNASSIGNED: ICI myocarditis is associated with changes in AST, ALT, and CPK. An increase in noncardiac biomarkers during ICI treatment, notably CPK, should prompt further evaluation for ICI myocarditis.
UNASSIGNED: The authors examined biomarker trends of patients on ICI and their association with the incidence of ICI myocarditis and outcomes.
UNASSIGNED: We conducted an observational cohort study of adults who received at least one dose of ICI at Michigan Medicine between June 2014 and December 2021 and underwent systematic serial testing for aspartate aminotransferase (AST) and alanine aminotransferase (ALT), creatine phosphokinase (CPK), and lactate dehydrogenase during ICI therapy.
UNASSIGNED: Among 2,606 patients (mean age 64 ± 13 years; 60.7% men), 27 (1.0%) were diagnosed with ICI myocarditis. At diagnosis, patients with myocarditis had an elevated high-sensitivity troponin T (100%), ALT (88.9%), AST (85.2%), CPK (88.9%), and lactate dehydrogenase (92.6%). Findings were confirmed in an independent cohort of 30 patients with biopsy-confirmed ICI myocarditis. A total of 95% of patients with ICI myocarditis had elevations in at least 3 biomarkers compared with 5% of patients without myocarditis. Among the noncardiac biomarkers, only CPK was associated (per 100% increase) with the development of myocarditis (HR: 1.83; 95% CI: 1.59-2.10) and all-cause mortality (HR: 1.10; 95% CI: 1.01-1.20) in multivariable analysis. Elevations in CPK had a sensitivity of 99% and specificity of 23% for identifying myocarditis.
UNASSIGNED: ICI myocarditis is associated with changes in AST, ALT, and CPK. An increase in noncardiac biomarkers during ICI treatment, notably CPK, should prompt further evaluation for ICI myocarditis.
摘要：
未经证实：心肌炎是免疫检查点抑制剂（ICI）的一种可怕且不可预测的并发症。我们试图确定常规测量的生物标志物是否有助于监测ICI心肌炎。
UNASSIGNED：作者研究了ICI患者的生物标志物趋势及其与ICI心肌炎发生率和预后的关系。
UNASSIGNED：我们对2014年6月至2021年12月期间在密歇根医学接受至少一剂ICI的成年人进行了观察性队列研究，并对天冬氨酸氨基转移酶（AST）和丙氨酸氨基转移酶（ALT）进行了系统的连续测试。肌酸磷酸激酶（CPK），ICI治疗期间的乳酸脱氢酶。
未经证实：在2,606名患者中（平均年龄64±13岁；60.7%为男性），27例(1.0%)被诊断为ICI心肌炎。诊断时,心肌炎患者高敏肌钙蛋白T升高（100%），ALT（88.9%），AST（85.2%），CPK（88.9%），乳酸脱氢酶(92.6%)。研究结果在30例经活检证实的ICI心肌炎患者的独立队列中得到证实。总共95%的ICI心肌炎患者至少有3种生物标志物升高，而没有心肌炎的患者为5%。在非心脏生物标志物中，在多变量分析中,只有CPK(每增加100%)与心肌炎(HR:1.83;95%CI:1.59-2.10)和全因死亡率(HR:1.10;95%CI:1.01-1.20)的发生相关.CPK升高对确定心肌炎的敏感性为99％，特异性为23％。
未经证实：ICI心肌炎与AST的变化有关，ALT,CPK。ICI治疗期间非心脏生物标志物的增加，特别是CPK,应提示对ICI心肌炎的进一步评估。
UNASSIGNED：作者研究了ICI患者的生物标志物趋势及其与ICI心肌炎发生率和预后的关系。
UNASSIGNED：我们对2014年6月至2021年12月期间在密歇根医学接受至少一剂ICI的成年人进行了观察性队列研究，并对天冬氨酸氨基转移酶（AST）和丙氨酸氨基转移酶（ALT）进行了系统的连续测试。肌酸磷酸激酶（CPK），ICI治疗期间的乳酸脱氢酶。
未经证实：在2,606名患者中（平均年龄64±13岁；60.7%为男性），27例(1.0%)被诊断为ICI心肌炎。诊断时,心肌炎患者高敏肌钙蛋白T升高（100%），ALT（88.9%），AST（85.2%），CPK（88.9%），乳酸脱氢酶(92.6%)。研究结果在30例经活检证实的ICI心肌炎患者的独立队列中得到证实。总共95%的ICI心肌炎患者至少有3种生物标志物升高，而没有心肌炎的患者为5%。在非心脏生物标志物中，在多变量分析中,只有CPK(每增加100%)与心肌炎(HR:1.83;95%CI:1.59-2.10)和全因死亡率(HR:1.10;95%CI:1.01-1.20)的发生相关.CPK升高对确定心肌炎的敏感性为99％，特异性为23％。
未经证实：ICI心肌炎与AST的变化有关，ALT,CPK。ICI治疗期间非心脏生物标志物的增加，特别是CPK,应提示对ICI心肌炎的进一步评估。
