Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI

被引：524

作者：

Blount, Benjamin C. ^{[1
]}

Karwowski, Mateusz P. ^{[1
]}

Shields, Peter G. ^{[12
,13
]}

Morel-Espinosa, Maria ^{[1
]}

Valentin-Blasini, Liza ^{[1
]}

Gardner, Michael ^{[1
]}

Braselton, Martha ^{[1
]}

Brosius, Christina R. ^{[1
]}

Caron, Kevin T. ^{[1
]}

Chambers, David ^{[1
]}

Corstvet, Joseph ^{[1
]}

Cowan, Elizabeth ^{[1
]}

De Jesus, Victor R. ^{[1
]}

Espinosa, Paul ^{[1
]}

Fernandez, Carolina ^{[1
]}

Holder, Cory ^{[1
]}

Kuklenyik, Zsuzsanna ^{[1
]}

Kusovschi, Jennifer D. ^{[1
]}

Newman, Cody ^{[1
]}

Reis, Gregory B. ^{[1
]}

Rees, Jon ^{[1
]}

Reese, Chris ^{[1
]}

Silva, Lalith ^{[1
]}

Seyler, Tiffany ^{[1
]}

Song, Min-Ae ^{[14
]}

Sosnoff, Connie ^{[1
]}

Spitzer, Carleen R. ^{[15
]}

Tevis, Denise ^{[1
]}

Wang, Lanqing ^{[1
]}

Watson, Cliff ^{[1
]}

Wewers, Mark D. ^{[15
]}

Xia, Baoyun ^{[1
]}

Heitkemper, Douglas T. ^{[16
]}

Ghinai, Isaac ^{[2
,17
]}

Layden, Jennifer ^{[17
]}

Briss, Peter ^{[3
]}

King, Brian A. ^{[4
]}

Delaney, Lisa J. ^{[5
]}

Jones, Christopher M. ^{[6
]}

Baldwin, Grant T. ^{[7
]}

Patel, Anita ^{[8
]}

Meaney-Delman, Dana ^{[9
]}

Rose, Dale ^{[10
]}

Krishnasamy, Vikram ^{[11
]}

Barr, John R. ^{[1
]}

Thomas, Jerry ^{[1
]}

Pirkle, James L. ^{[1
]}

机构：

[1] Ctr Dis Control & Prevent, Natl Ctr Environm Hlth, Div Sci Lab, Atlanta, GA USA

[2] Ctr Dis Control & Prevent, Ctr Surveillance Epidemiol & Lab Sci, Epidem Intelligence Serv, Atlanta, GA USA

[3] Ctr Dis Control & Prevent, Off Director, Atlanta, GA USA

[4] Ctr Dis Control & Prevent, Off Smoking & Hlth, Atlanta, GA USA

[5] Ctr Dis Control & Prevent, Natl Ctr Chron Dis Prevent & Hlth Promot, Off Director, Natl Inst Occupat Safety & Hlth, Atlanta, GA USA

[6] Ctr Dis Control & Prevent, Off Strategy & Innovat, Atlanta, GA USA

[7] Ctr Dis Control & Prevent, Div Overdose Prevent, Atlanta, GA USA

[8] Ctr Dis Control & Prevent, Natl Ctr Injury Prevent & Control, Off Director, Natl Ctr Immunizat & Resp Dis, Atlanta, GA USA

[9] Ctr Dis Control & Prevent, Natl Ctr Birth Defects & Dev Disabil, Div Birth Defects & Infant Disorders, Atlanta, GA USA

[10] Ctr Dis Control & Prevent, Natl Ctr Emerging & Zoonot Infect Dis, Div Preparedness & Emerging Infect, Atlanta, GA USA

[11] Ctr Dis Control & Prevent, Natl Ctr Injury Prevent & Control, Off Director, Atlanta, GA USA

[12] Ohio State Univ, Comprehens Canc Ctr, Columbus, OH 43210 USA

[13] Ohio State Univ, James Canc Hosp, Columbus, OH 43210 USA

[14] Ohio State Univ, Coll Publ Hlth, Div Environm Hlth Sci, Columbus, OH 43210 USA

[15] Ohio State Univ, Dept Internal Med, Pulm & Crit Care Med, Columbus, OH 43210 USA

[16] Food & Drug Adm, Silver Spring, MD USA

[17] Illinois Dept Publ Hlth, Chicago, IL USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2020年 / 382卷 / 08期

关键词：

E-CIGARETTE; UNITED-STATES; PULMONARY SURFACTANT; LUNG INJURIES; PRODUCT; OUTBREAK;

D O I：

10.1056/NEJMoa1916433

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background The causative agents for the current national outbreak of electronic-cigarette, or vaping, product use-associated lung injury (EVALI) have not been established. Detection of toxicants in bronchoalveolar-lavage (BAL) fluid from patients with EVALI can provide direct information on exposure within the lung. Methods BAL fluids were collected from 51 patients with EVALI in 16 states and from 99 healthy participants who were part of an ongoing study of smoking involving nonsmokers, exclusive users of e-cigarettes or vaping products, and exclusive cigarette smokers that was initiated in 2015. Using the BAL fluid, we performed isotope dilution mass spectrometry to measure several priority toxicants: vitamin E acetate, plant oils, medium-chain triglyceride oil, coconut oil, petroleum distillates, and diluent terpenes. Results State and local health departments assigned EVALI case status as confirmed for 25 patients and as probable for 26 patients. Vitamin E acetate was identified in BAL fluid obtained from 48 of 51 case patients (94%) in 16 states but not in such fluid obtained from the healthy comparator group. No other priority toxicants were found in BAL fluid from the case patients or the comparator group, except for coconut oil and limonene, which were found in 1 patient each. Among the case patients for whom laboratory or epidemiologic data were available, 47 of 50 (94%) had detectable tetrahydrocannabinol (THC) or its metabolites in BAL fluid or had reported vaping THC products in the 90 days before the onset of illness. Nicotine or its metabolites were detected in 30 of 47 of the case patients (64%). Conclusions Vitamin E acetate was associated with EVALI in a convenience sample of 51 patients in 16 states across the United States. (Funded by the National Cancer Institute and others.) In a study involving 51 patients with electronic-cigarette, or vaping, product use-associated lung injury in 16 states across the United States, vitamin E acetate was detected in samples of bronchoalveolar-lavage fluid from 94% of the patients but not in samples from a healthy comparator group.

引用

页码：697 / 705

页数：9

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