Routine laboratory test to assess the need of respiratory support in acute bronchiolitis

Abstract

Background and Objectives: Accurate and readily available biomarkers to predict the clinical course of bronchiolitis would enable enhanced decision-making in this setting. We explored the relationship of several biochemical parameters available at the pediatric emergency care setting with the need of advanced respiratory support (ARS): continuous positive airway pressure (CPAP), biphasic positive airway pressure (BiPAP), or invasive mechanical ventilation (MV) in bronchiolitis.Methods: Single-center, prospective, observational, including infants aged less than 12 months diagnosed with acute bronchiolitis at the Pediatric Emergency Department. Determination of plasmatic values of several laboratory tests was performed at the time of hospital admission. Multivariate logistic analysis identified independent predictors for need of ARS.Results: From October 1, 2018 to May 1, 2020, we recruited 149 infants (58% males; median age of 1 [0.5-2.5] month). Thirty-seven (25%) cases required ARS.After adjusting by age, bacterial superinfection, and comorbidities in the multivariate analysis, only higher levels of glycemia (p = 0.001), C-reactive protein (CRP) (p = 0.028), CRP/albumin ratio (p = 0.032), and NT-proBNP (p = 0.001) remained independently associated with ARS. These biomarkers reached moderate prediction accuracy with area under the curve of receiver operator curve curves ranging from 0.701 to 0.830 (p = 0.001). All they presented relatively high specificity (0.75-0.84) and negative predictive values (0.77-0.89) with low sensitivity and positive predictive values. They also correlated significantly with length of stay hospitalization (p = 0.001). Conclusion:Increased plasmatic levels of CRP, CRP/albumin ratio, glycemia, and NT-proBNP at hospital admission are associated with the need for ARS in infants with acute bronchiolitis.

Correlation between urinary and serum NT‐proBNP in acute bronchiolitis: A pilot study

“…There is increasing evidence supporting the role of NT-proBNP as a biomarker for myocardial strain in infants with severe bronchiolitis, and that it could help screen patients with a worse clinical evolution when used in conjunction with clinical scores. 5,33,34 In acute bronchiolitis, the airway obstruction and inflammation would affect pulmonary vascular tone increasing the right ventricular afterload with subsequent biventricular dysfunction, 8,35,36 leading to an increased release of NT-proBNP. This could be an explanation for the significant association observed between elevated urinary NT-proBNP concentrations and increased pCO 2 , CRP, and procalcitonin levels in our patients.…”

“…There has been recent research interest in NT‐proBNP as a reliable biomarker in several pediatric scenarios 4 . Increasing evidence supports the use of serum NT‐proBNP levels as a potential biomarker of myocardial strain and disease severity for respiratory conditions, including acute bronchiolitis 5–8 . Serial monitoring of serum NT‐proBNP concentrations in these infants would require multiple blood sampling through venipuncture in an otherwise vulnerable population.…”

Correlation between urinary and serum NT-proBNP in acute bronchiolitis. A pilot study

“…Recent work shows that serum NT-proBNP levels are associated with echocardiographic signs of pulmonary hypertension and subclinical myocardial dysfunction. It could help screen patients with a worse clinical evolution when used in conjunction with clinical scores [5,27,28]. In acute bronchiolitis, the airway obstruction and inflammation would affect pulmonary vascular tone increasing the right ventricular afterload [8,29,30], leading to an increased release of NT-proBNP.…”

“…There has been recent research interest in NT-proBNP as a reliable biomarker in several pediatric scenarios [4]. Increasing evidence supports the use of serum NT-proBNP levels as a potential biomarker of myocardial strain and disease severity for respiratory conditions, including acute bronchiolitis [5][6][7][8]. Serial monitoring of serum NT-proBNP concentrations in these infants would require multiple blood sampling through venipuncture in an otherwise vulnerable population.…”