Lactate dehydrogenase and caspase activity in nasopharyngeal secretions are predictors of bronchiolitis severity

Abstract

BackgroundBronchiolitis is the leading cause of hospitalization in infants. Biomarkers of disease severity might help in clinical management.ObjectiveTo determine the clinical predictiveness of NW-LDH, NW-caspase 3/7, and NW-LDH/NW-caspase 3/7 ratio in bronchiolitis.MethodsPreviously healthy children less than 24 months of age with bronchiolitis were recruited from the Texas Children's emergency room and intensive care unit from October 2010 to April 2011. Demographic, clinical information, and NW samples were obtained at enrollment. NW samples were analyzed for respiratory viruses, caspase 3/7, and LDH.ResultsA viral pathogen was detected in 91·6% of 131 children, with the most common being respiratory syncytial virus and human rhinovirus. A single infection was found in 61·8% of subjects and co-infection in 29·8%. Children admitted to ICU had significantly higher NW-LDH than children sent home from the ER or admitted to the general floor (P = 0·02). Children infected with RSV had the highest NW-LDH concentration (P = 0·03) compared with other viral infections. NW-LDH and NW-caspase were significantly correlated (r = 0·77, P < 0·0001). The univariate models showed NW-LDH and NW-LDH/NW- caspase 3/7 ratio were directly associated with hospitalization. Mutivariate regression analyses suggested a complex interaction between the biomarkers, demographics, and disposition.ConclusionsNW-LDH, NW-caspase 3/7 and NW-LDH/NW-caspase 3/7 ratio and their interactions with demographic factors are predictive of bronchiolitis severity and can help distinguish children requiring ICU-level care from those admitted to the general floor, or discharged home from the emergency center.

The interdependencies of viral load, the innate immune response, and clinical outcome in children presenting to the emergency department with respiratory syncytial virus-associated bronchiolitis

“…Findings from this study have been previously reported [13, 15]. Healthy children less than 24 months of age without a known co-morbid condition who presented to the ED with respiratory distress and were diagnosed with bronchiolitis by their attending physician were eligible for study participation [13].…”

Considering lactate dehydrogenase (LDH) concentration in nasal-wash (NW) as a marker in evaluating the outcome of patients with bronchiolitis

“…Also, apposite to the findings of this study, the study of Rahman et al in 55 children over 6months of age with bronchiolitis found a straight relationship between the concentration of LDH of NW and the outcomes of bronchiolitis in children. 5 In their study LDH concentration of NW had a significant positive correlation with the severity of the disease, duration of hospitalization and the duration of oxygen therapy which can be due to fewer newborns and limitation in age up 6months.…”

“…4 The study by Mehta et al in the United States showed that LDH concentration in the NW in children aged 4 to 12months has an inverse relationship with the risk of admission but in the 12-24month children with a straight relationship was at risk of being hospitalized. 5 The study of Rahman et al in Egypt also showed that there was a significant straight relationship between the LDH concentration in NW in children older than 6months with severity of bronchiolitis, duration of hospitalization and oxygen therapy. 6 …”

“…However according to recent findings on bronchiolitis which showed that higher levels of LDH in nasal rinse were associated with a lower risk of hospitalization. 2,3,5 At present the number of studies conducted in this area is limited in the world and the results of their findings in some countries have been partly contradictory and some studies have shown that there is a reverse and direct relationship between LDH concentration and severity of bronchiolitis. Considering the need for a marker to determine the outcomes of children with bronchiolitis and the limited studies conducted in the world and the lack of a study in Iran, the aim of this study was to investigate LDH in NW as a marker in evaluating the outcome of patients with bronchiolitis in Bu-Ali hospital in Ardabil city, Iran.…”

The modified respiratory index score (RIS) guides resource allocation in acute bronchiolitis

“…In view of this, we postulate that our clinical predictive model may improve with the addition of nasal biomarkers. Nasal wash lactate dehydrogenase and nasal wash caspase were previously reported to value add in predicting bronchiolitis severity, specifically those requiring intensive care monitoring . While these remain exploratory, they hold potential to strengthen the robustness of prediction models.…”