Nasal high‐mobility group box 1 and caspase in bronchiolitis

Abstract

Objective Nasal biomarkers have potential to add objectivity to the clinical assessment of the child with bronchiolitis. We aim to study, if nasal caspase and high‐mobility group box 1 protein (HMGB1) levels differ between patients who were hospitalized and those discharged from the emergency department (ED), among patients with bronchiolitis. Methods Using an observational cross‐sectional study design, we recruited patients younger than 24 months presenting to the ED from September 1, 2015 to May 31, 2017 with a diagnosis of acute bronchiolitis. We described the patients’ clinical severity measured by the modified respiratory index score (RIS), and performed standardized collection and analysis of nasal caspase and HMGB1 levels. Results Among 85 patients recruited, the median age was 5.0 months (interquartile range, IQR 3.3‐7.2) and the median modified RIS score was 3 (IQR 2‐4). Hospitalized patients had a 2.4‐fold higher HMGB1 level than patients who were discharged from the ED (2.558 μg/mL [IQR 1.038‐5.125] vs 1.056 μg/mL [IQR 0.409‐2.395], P = 0.0013). There was no difference in median caspase level between hospitalized and discharged patients. The Area Under the Receiver Operating Characteristics curve predicting hospitalization was 0.7021 for HMGB1 compared to 0.5709 for RIS in this bronchiolitis cohort. Conclusions Our study findings show that nasal HMGB1 levels significantly differentiate between young children with bronchiolitis who were hospitalized compared to those fit for discharge. This exploratory study holds potential for future research on nasal HMGB1 for severity stratification in young children with acute bronchiolitis.

Urinary club cell protein 16 (CC16): Utility of its assay during acute bronchiolitis

“…It is important to know whether it is the initial epithelial injury that is responsible for severity and sequelae, or whether the inflammatory response to the viral agent predisposes the patient to relapses. Much effort has been made to identify novel biological markers measurable during the course of acute bronchiolitis for clinically effective prediction of disease severity and later wheezing . Our team has studied epithelial injury biomarkers in acute bronchiolitis, but found no correlation between serum levels of KL‐6 2 , or serum‐soluble receptor for advanced glycation end‐product, and severity of acute bronchiolitis and risk of wheezing bronchitis.…”

Validity of clinical severity scores for respiratory syncytial virus: a systematic review

“…Chong et al [24] reported that the mRIS, a modified version of the Tal score (albeit different from the modified Tal score [mTal]) had a fair ability at discriminating between those who required non-invasive respiratory support, but a poor ability at discriminating by admission, intravenous hydration and LOS≥ 2 days. Another publication [25] using a subset of the same dataset similarly reported a poor ability of the mRIS at discriminating by admission.…”

The performance of the alarmin HMGB1 in pediatric diseases: From lab to clinic

“…In addition to clinical studies, HMGB1 levels in bronchoalveolar lavage fluid and lung tissue were significantly increased in animal models of pneumonia induced by adenovirus infection, and the expression of the receptors TLR4/9 and RAGE also varied with the changes in HMGB1, confirming that the HMGB1 signaling pathway plays a role in the occurrence and development of adenovirus‐mediated pneumonia 80 . The level of HMGB1 in the nasal secretions of children with bronchiolitis requiring hospitalization was significantly higher than those of children who were allowed to leave the hospital after emergency treatment, which makes it possible to grade the severity of acute bronchiolitis in children by measuring HMGB1 in nasal secretions 81 . Furthermore, HMGB1 was significantly increased in the serum of children with severe pneumonia who were infected with H1N1 influenza virus and was significantly associated with the upregulation of 10 other cytokines 80 .…”