Clinical and molecular associations with outcomes at 2 years after acute knee injury: a longitudinal study in the Knee Injury Cohort at the Kennedy (KICK).
Clinical and molecular associations with outcomes at 2 years after acute knee injury: a longitudinal study in the Knee Injury Cohort at the Kennedy (KICK).
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急性膝盖损伤后2年的临床和分子关联：在肯尼迪（KICK）的膝盖损伤队列中进行的一项纵向研究。
DOI：
10.1016/s2665-9913(21)00116-8
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发表时间：
2021-09
期刊：
影响因子：
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通讯作者：
Watt FE
中科院分区：
文献类型：
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作者：
Garriga C;Goff M;Paterson E;Hrusecka R;Hamid B;Alderson J;Leyland K;Honeyfield L;Greenshields L;Satchithananda K;Lim A;Arden NK;Judge A;Williams A;Vincent TL;Watt FE
关节损伤是骨关节炎的主要危险因素，并提供了前瞻性检查与骨关节炎相关的早期过程。膝盖受伤2年后的结果。
这项纵向队列研究在2010年11月1日至2014年11月28日之间招募了16-50岁的人，在英国伦敦的六家医院和诊所都在临床上具有重要意义的急性膝盖受伤后（积液和诊所）。 MRI的结构损伤），通常是通过手术治疗的。关节损伤的采样，程度和类型，滑液血液染色，积液的存在，自我报告的性别，年龄和BMI），并通过基线和3个月的免疫测量测量了12个滑液和四个血浆或血清生物标志物结果是膝关节损伤和骨关节炎的结果评分（KOOS4），在所有患者中都对基线评分进行了调整。预定义的协变量用于评估基线变量与2年KOOS4之间的关联。
我们在膝盖受伤后的17天（1-59，IQR 9-26）中招募了150名患者。 ）。参与者有所有必要的变量可用，并在2年的核心变量调整后分析中包括在基线时的38（SD 18）中，在2年的基线KOOS4中提高了膝盖积液，中度至重度滑膜血染及其相互作用显着预测了2年Koos4（n = 77;临界-20·5，95％CI -34·8至-6·18; p = 0·0060）。 ML单位; p = 0·011）和IL-6（n = 77; -0·0005，-0·0009至-0·0001在1 pg/ml单位中; p = 0·017） ，结合积液和血液染色的相互作用在血液采样时，发生了两个不良事件的结果变异性。
急性膝关节损伤后，积液和血肿的结合与症状的结合显着相关。 ，与临床预测指标相比，生物标志物总体上发挥了较小的作用。在此过程的早期，必须更好地理解它们的明显解离，以取得临床进展。
与关节炎，肯尼迪风湿病研究信任和NIHR牛津生物医学研究中心。
Joint injury is a major risk factor for osteoarthritis and provides an opportunity to prospectively examine early processes associated with osteoarthritis. We investigated whether predefined baseline demographic and clinical factors, and protein analytes in knee synovial fluid and in plasma or serum, were associated with clinically relevant outcomes at 2 years after knee injury. This longitudinal cohort study recruited individuals aged 16–50 years between Nov 1, 2010, and Nov 28, 2014, across six hospitals and clinics in London, UK. Participants were recruited within 8 weeks of having a clinically significant acute knee injury (effusion and structural injury on MRI), which was typically treated surgically. We measured several predefined clinical variables at baseline (eg, time from injury to sampling, extent and type of joint injury, synovial fluid blood staining, presence of effusion, self-reported sex, age, and BMI), and measured 12 synovial fluid and four plasma or serum biomarkers by immunoassay at baseline and 3 months. The primary outcome was Knee Injury and Osteoarthritis Outcome Score (KOOS4) at 2 years, adjusted for baseline score, assessed in all patients. Linear and logistic regression models adjusting for predefined covariates were used to assess associations between baseline variables and 2-year KOOS4. This study is registered with ClinicalTrials.gov, number NCT02667756. We enrolled 150 patients at a median of 17 days (range 1–59, IQR 9–26) after knee injury. 123 (82%) were male, with a median age of 25 years (range 16–50, IQR 21–30). 98 (65%) of 150 participants completed a KOOS4 at 2 (or 3) years after enrolment (50 participants were lost to follow-up and two were withdrawn due to adverse events unrelated to study participation); 77 (51%) participants had all necessary variables available and were included in the core variable adjusted analysis. In the 2-year dataset mean KOOS4 improved from 38 (SD 18) at baseline to 79 (18) at 2 years. Baseline KOOS4, medium-to-large knee effusion, and moderate-to-severe synovial blood staining and their interaction significantly predicted 2-year KOOS4 (n=77; coefficient −20·5, 95% CI −34·8 to −6·18; p=0·0060). The only predefined biomarkers that showed independent associations with 2-year KOOS4 were synovial fluid MCP-1 (n=77; −0·015, 0·027 to −0·004 per change in 1 pg/mL units; p=0·011) and IL-6 (n=77; −0·0005, −0·0009 to −0·0001 per change in 1 pg/mL units; p=0·017). These biomarkers, combined with the interaction of effusion and blood staining, accounted for 39% of outcome variability. Two adverse events occurred that were linked to study participation, both at the time of blood sampling (one presyncopal episode, one tenderness and pain at the site of venepuncture). The combination of effusion and haemarthrosis was significantly associated with symptomatic outcomes after acute knee injury. The synovial fluid molecular protein response to acute knee injury (best represented by MCP-1 and IL-6) was independently associated with symptomatic outcomes but not with structural outcomes, with the biomarkers overall playing a minor role relative to clinical predictors. The relationship between symptoms and structure after acute knee injury and their apparent dissociation early in this process need to be better understood to make clinical progress. Versus Arthritis, Kennedy Trust for Rheumatology Research, and NIHR Oxford Biomedical Research Centre.