A clustering approach to identify severe bronchiolitis profiles in children

Abstract

Objective Although bronchiolitis is generally considered a single disease, recent studies suggest heterogeneity. We aimed to identify severe bronchiolitis profiles using a clustering approach. Methods We analyzed data from two prospective, multi-center cohorts of children younger than 2 years hospitalized with bronchiolitis, one in the U.S. (2007–2010 winter seasons, n=2,207) and one in Finland (2008–2010 winter seasons, n=408). Severe bronchiolitis profiles were determined by latent class analysis, classifying children based on clinical factors and viral etiology. Results In the U.S. study, four profiles were identified. Profile A (12%) was characterized by history of wheezing and eczema, wheezing at the ED presentation and rhinovirus infection. Profile B (36%) included children with wheezing at the ED presentation, but, in contrast to profile A, most did not have history of wheezing or eczema; this profile had the largest probability of RSV-infection. Profile C (34%) was the most severely ill group, with longer hospital stay and moderate-to-severe retractions. Profile D (17%) had the least severe illness, including non-wheezing children with shorter length-of-stay. Two of these profiles (A and D) were replicated in the Finnish cohort; a third group (“BC”) included Finnish children with characteristics of profiles B and/or C in the U.S. population. Conclusion Several distinct clinical profiles (phenotypes) were identified by a clustering approach in two multicenter studies of children hospitalized for bronchiolitis. The observed heterogeneity has important implications for future research on the etiology, management and long-term outcomes of bronchiolitis, such as future risk of childhood asthma.

Assessing the association between bronchiolitis in infancy and recurrent wheeze: a whole English birth cohort case–control study

“…That the association for early wheeze is stronger implies that this is more complicated than the revealing of an innate state. It may be that different clinical phenotypes of bronchiolitis13 would be helpful in this prognostication, but we were not able to assess this using this dataset.…”

Early Halt of a Randomized Controlled Study with 3% Hypertonic Saline in Acute Bronchiolitis

“…3% HS nebulizations cause minor and severe adverse events as seen in our study. The association between adverse events and the potential role of nebulization, medication and nebulizer utilized, and bronchiolitis phenotype [31] needs further exploration.…”

Uso de broncodilatadores en bronquiolitis: ¿sí o no?

“…Todo lo anterior pone en evidencia que la bronquiolitis es una enfermedad heterogénea en su cuadro clínico y que depende de diversos factores, como el virus patógeno y su interacción con el microbioma de la vía aérea, la respuesta inmune, la genética del huésped y factores ambientales. 8,9 Por lo tanto, es muy probable que un mismo esquema terapéutico no sea lo más adecuado para tratar a todos los pacientes.…”