Hypoxemia is an independent predictor of bronchiolitis obliterans following respiratory adenoviral infection in children

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.

Aetiology and risks factors associated with the fatal outcomes of childhood pneumonia among hospitalised children in the Philippines from 2008 to 2016: a case series study

“…In a multicentre study that included 5 LMIC, the CFR among the hypoxaemic patients was 8.5%,59 which is lower than the range of CFRs (12.6%–15.7%)%) reported among hypoxaemic patients in this study. Hypoxaemia was associated with viral infections such as RV and RSV as well as with a poor outcome, particularly in ADV infection 60–64. In this study, hypoxaemia was significantly associated with death in patients infected with RV, RSV and ADV and in those with particularly high adjusted OR for ADV.…”

Bronchiolitis obliterans after severe adenovirus pneumonia:a review of 46 cases

“…shown that mechanical ventilation is a risk factor for the formation of BO (15,16) , 67.7% (155 / 229) of children with severe adenovirus pneumonia received different levels of oxygen support. The rate of mechanical ventilation and hypoxemia were signi cantly higher in the wave group than in the non-wave group (39.1% and 7.1%, respectively,P = 0.000), suggesting that the risk factors for mechanical ventilation and hypoxemia were adenovirus infection due to bronchiolitis obturator, which is consistent with Wu Pei qiong et al (17) . On the one hand, hypoxemia signi cantly affects the expression of cytokines, chemokines and chemokine receptors, which signi cantly increases the incidence and severity of BOS.…”

Risk factors for the development of bronchiolitis obliterans in children with severe adenovirus pneumonia: A retrospective study with dose‐response analysis

“…It's different with other researchers have reported. 7,8,10 A number of studies have shown that mechanical ventilation is an independent risk factor for BO with adenovirus infection. [7][8][9] Our study discovered that the rate of invasive mechanical ventilation in BO group was significantly higher than that in non-BO group.…”

“…Previous studies have found that hospital stay longer than 30 days, multiple pulmonary lobes involvement, hypercapnia and hypoxemia are high risk factors for the development of BO after adenovirus infection. 6,7,10 A prospective study by Castro-Rodriguez et al 8 found that children with adenovirus pneumonia who developed BO had higher rate of ICU admission, requiring oxygen therapy, and use of systemic glucocorticoids and beta agonists. We also found that patients in BO group had longer hospital stay, while it was not independent risk factor for BO.…”