Predictive Value of Adenoviral Load for Bronchial Mucus Plugs Formation in Children with Adenovirus Pneumonia

Abstract

Background. The study aimed to explore risk factors for bronchial mucus plugs (BMP) formation in children with adenovirus (AdV) pneumonia. Methods. A retrospective study was conducted on children with AdV pneumonia who underwent bronchoscopy from January 2019 to December 2019. Children were divided into the BMP group and the control group, depending on whether BMP was formed or not. The clinical information and treatment proposals of the two groups of children were counted and analyzed via multiple logistic regression analysis, ROC curve analysis, and correlation analysis. Results. Among 453 patients with AdV pneumonia, 185 (40.84%) were in the BMP group. Among all the cases, there were 188 patients with a single AdV infection, including 64 (34.04%) in the BMP group and 124 (65.96%) in the control group. The incidence of dyspnea, poor spirits, mixed infections, and other symptoms in the BMP group was higher than in the control group. Children in the BMP group had a longer heat range. C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer (DD), and AdV load levels were higher in the MBP group. AdV load, Mycoplasma coinfection, DD, heat range, and LDH were independent risk factors for BMP, among which AdV load was the most significant (AUC = 0.819). AdV load was positively correlated with other risk factors, respectively. AdV load and heat range were independent risk factors for BMP patients with a single AdV infection. Conclusion. AdV load might have important clinical value in predicting BMP development in AdV pneumonia.

Lactate dehydrogenase and the severity of adenoviral pneumonia in children: A meta-analysis

“…Besides, pooled results of 6 studies ( 18 , 20 , 23 , 32 , 35 , 36 ) indicated that the pretreatment LDH was significantly higher in children who developed PIBO as compared to those who did not (SMD: 0.47, 95% CI: 0.09 to 0.84, p = 0.02, I 2 = 80%; Figure 2B ). Sensitivity analysis by omitting one study at a time also showed consistent results (SMD: 0.23 to 0.57, p all < 0.05).…”

“…The treatments during hospitalization were only reported in eight studies ( 15 , 18 , 20 , 22 , 23 , 34 – 36 ), which included symptomatic and supporting treatments, oral prednisone and intravenous steroids, intravenous immunoglobulin, antiviral ribavirin, and respiratory support if necessary ( Table 1 ). The follow-up durations were within hospitalization in most of the included studies, while others were with a follow-up duration of 1 month ( 36 ), 3 months ( 20 , 35 ), and 12 months ( 18 , 23 , 32 ). As for the outcomes reported, 14 studies reported the difference of LDH level at baseline between children with severe and non-severe ADVP ( 14 , 16 , 17 , 19 , 21 , 24 – 31 , 33 ), 6 studies reported the difference of LDH level at baseline between children who developed and did not develop PIBO ( 18 , 20 , 23 , 32 , 35 , 36 ), and three studies reported the association between LDH admission and in-hospital mortality of children with ADVP ( 15 , 22 , 34 ).…”

“…The follow-up durations were within hospitalization in most of the included studies, while others were with a follow-up duration of 1 month ( 36 ), 3 months ( 20 , 35 ), and 12 months ( 18 , 23 , 32 ). As for the outcomes reported, 14 studies reported the difference of LDH level at baseline between children with severe and non-severe ADVP ( 14 , 16 , 17 , 19 , 21 , 24 – 31 , 33 ), 6 studies reported the difference of LDH level at baseline between children who developed and did not develop PIBO ( 18 , 20 , 23 , 32 , 35 , 36 ), and three studies reported the association between LDH admission and in-hospital mortality of children with ADVP ( 15 , 22 , 34 ). The NOS of the included studies were all six to seven stars, suggesting moderate to good study quality ( Table 2 ).…”

“…6 studies reported the difference of LDH level at baseline between children who developed and did not developPIBO (18, 20, 23,32, 35, 36), and three studies reported the association between LDH admission and in-hospital mortality of children with ADVP (15, 22, 34). The NOS of the included studies were all six to seven stars, suggesting moderate to good study quality (Table2).…”