Abstract
Bronchiolitis obliterans (BO) is an uncommon and severe sequela of chronic obstructive lung disease in children that results from an insult to the lower respiratory tract. Few prognostic factors achieved worldwide acknowledgment. In the present study, we retrospectively collected the children with respiratory adenoviral infection and identified the predictive factors of BO. In the period between Jan 2011 and December 2014, the consecutive in-hospital acute respiratory infection children with positive result for adenovirus were enrolled into the present study. High resolution computerized tomography and clinical symptoms were utilized as the diagnostic technique for BO. Multivariate analysis using a Logistic proportional hazards model was used to test for independent predictors of BO. A total of 544 children were included with 14 (2.57 %) patients developed BO. Compared with children without BO, BO children presented higher LDH (523.5 vs. 348 IU/ml, p = 0.033), lower blood lymphocyte count (2.23 × 109/L vs. 3.24 × 109/L, p = 0.025) and higher incidence of hypoxemia (78.6 vs. 20.8 %, p = 0.000). They presented relatively persistent fever (15.5 vs. 7 days, p = 0.000) and needed longer treatment in hospital (19.5 vs. 7 days, p = 0.000). Concerning treatment, they were given more intravenous γ-globulin (85.7 vs. 36.8 %, p = 0.000), glucocorticoids (78.6 vs. 24.3 %, p = 0.000) and mechanical ventilation (35.7 vs. 5.5 %, p = 0.001). Multiple analyses determined that hypoxemia was the only independent predictor for BO. The present study identified hypoxemia as the independent predictive factor of BO in adenoviral infected children, which was a novel and sensitive predictor for BO.
Highlights
Bronchiolitis obliterans (BO) is an uncommon and severe sequela of chronic obstructive lung disease in children that results from certain insult to the lower respiratory tract
Among the 544 children, 456 children were diagnosed through PCR and 56 were by serum IgM with the rest 32 diagnosed by both methods
The children had a median age of 23 months. 14 (2.57 %) patients developed BO who were all diagnosed pneumonia at admission
Summary
Bronchiolitis obliterans (BO) is an uncommon and severe sequela of chronic obstructive lung disease in children that results from certain insult to the lower respiratory tract. It is featured by tachypnoea, increased anteroposterior chest diameter, crackles, wheezing, and hypoxaemia for at least 30 days after the initial insult. Due to its poor prognosis and shortage of effective remedy, identification of predictive factors for BO became one of hottest topic in this field. Few prognostic factors achieved worldwide acknowledgment (Murtagh et al 2009; Colom and Teper 2009; Yalcin et al 2003; Khalifah et al 2004). The latent causes might be the heterogenicity of this disease
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