Giuseppe
Emeritus
LDH concentration in nasal-wash fluid as a biochemical predictor of bronchiolitis severity. (Pediatrics, abstract, edited)
29. Pediatrics. 2010 Feb;125(2):e225-33. Epub 2010 Jan 25.
LDH concentration in nasal-wash fluid as a biochemical predictor of bronchiolitis severity.
Laham FR, Trott AA, Bennett BL, Kozinetz CA, Jewell AM, Garofalo RP, Piedra PA. - Baylor College of Medicine, Department of Pediatrics, One Baylor Plaza, Room 248E (MS280), Houston, TX 77030, USA. laham@bcm.edu
OBJECTIVE:
Because the decision to hospitalize an infant with bronchiolitis is often supported by subjective criteria and objective indicators of bronchiolitis severity are lacking, we tested the hypothesis that lactate dehydrogenase (LDH), which is released from injured cells, is a useful biochemical indicator of bronchiolitis severity.
PATIENTS AND METHODS:
We retrospectively analyzed a study of children <24 months old presenting to the emergency department with bronchiolitis. Demographic, clinical information, nasal wash (NW), and serum specimens were obtained. NW samples were analyzed for respiratory viruses, caspase 3/7 activity, and a panel of cytokines and chemokines. Total LDH activity was tested in NW samples and sera.
RESULTS:
Of 101 enrolled children (median age: 5.6 months), 98 had NW specimens available. A viral etiology was found for 82 patients (83.6%), with respiratory syncytial virus (RSV) (66%) and rhinovirus (19%) being the most common viruses detected. Concentrations of LDH in NW specimens were independent from those in sera and were higher in children with RSV infection or with dual infection. Significant correlations were found between NW LDH and NW cytokines/chemokines. Similarly, NW LDH correlated with NW-caspase 3/7 activity (r = 0.75; P < .001). In a multivariate analysis, NW LDH concentration in the upper quartile was significantly associated with a reduced risk of hospitalization (odds ratio: 0.19 [95% confidence interval: 0.05-0.68]; P = .011).
CONCLUSIONS:
NW LDH levels in young children with bronchiolitis varied according to viral etiology and disease severity. Values in the upper quartile were associated with approximately 80% risk reduction in hospitalization, likely reflecting a robust antiviral response. NW LDH may be a useful biomarker to assist the clinician in the decision to hospitalize a child with bronchiolitis.
PMID: 20100751 [PubMed - indexed for MEDLINE]
Publication Types:
* Research Support, N.I.H., Extramural
MeSH Terms:
* Apoptosis/physiology
* Bronchiolitis/metabolism*
* Bronchiolitis/virology
* Cytokines/metabolism
* Female
* Hospitalization/statistics & numerical data
* Humans
* Infant
* Infant, Newborn
* L-Lactate Dehydrogenase/analysis*
* Logistic Models
* Male
* Multivariate Analysis
* Nasal Lavage Fluid/chemistry*
* Respiratory Syncytial Virus Infections/complications
* Respiratory Syncytial Virus Infections/metabolism
* Retrospective Studies
* Severity of Illness Index
Substances:
* Cytokines
* L-Lactate Dehydrogenase
Grant Support:
* N01 HV28184/HV/NHLBI NIH HHS/United States
* N01-AI-30039/AI/NIAID NIH HHS/United States
* P01 AI062885/AI/NIAID NIH HHS/United States
* T32 HD42977/HD/NICHD NIH HHS/United States
-
------
29. Pediatrics. 2010 Feb;125(2):e225-33. Epub 2010 Jan 25.
LDH concentration in nasal-wash fluid as a biochemical predictor of bronchiolitis severity.
Laham FR, Trott AA, Bennett BL, Kozinetz CA, Jewell AM, Garofalo RP, Piedra PA. - Baylor College of Medicine, Department of Pediatrics, One Baylor Plaza, Room 248E (MS280), Houston, TX 77030, USA. laham@bcm.edu
OBJECTIVE:
Because the decision to hospitalize an infant with bronchiolitis is often supported by subjective criteria and objective indicators of bronchiolitis severity are lacking, we tested the hypothesis that lactate dehydrogenase (LDH), which is released from injured cells, is a useful biochemical indicator of bronchiolitis severity.
PATIENTS AND METHODS:
We retrospectively analyzed a study of children <24 months old presenting to the emergency department with bronchiolitis. Demographic, clinical information, nasal wash (NW), and serum specimens were obtained. NW samples were analyzed for respiratory viruses, caspase 3/7 activity, and a panel of cytokines and chemokines. Total LDH activity was tested in NW samples and sera.
RESULTS:
Of 101 enrolled children (median age: 5.6 months), 98 had NW specimens available. A viral etiology was found for 82 patients (83.6%), with respiratory syncytial virus (RSV) (66%) and rhinovirus (19%) being the most common viruses detected. Concentrations of LDH in NW specimens were independent from those in sera and were higher in children with RSV infection or with dual infection. Significant correlations were found between NW LDH and NW cytokines/chemokines. Similarly, NW LDH correlated with NW-caspase 3/7 activity (r = 0.75; P < .001). In a multivariate analysis, NW LDH concentration in the upper quartile was significantly associated with a reduced risk of hospitalization (odds ratio: 0.19 [95% confidence interval: 0.05-0.68]; P = .011).
CONCLUSIONS:
NW LDH levels in young children with bronchiolitis varied according to viral etiology and disease severity. Values in the upper quartile were associated with approximately 80% risk reduction in hospitalization, likely reflecting a robust antiviral response. NW LDH may be a useful biomarker to assist the clinician in the decision to hospitalize a child with bronchiolitis.
PMID: 20100751 [PubMed - indexed for MEDLINE]
Publication Types:
* Research Support, N.I.H., Extramural
MeSH Terms:
* Apoptosis/physiology
* Bronchiolitis/metabolism*
* Bronchiolitis/virology
* Cytokines/metabolism
* Female
* Hospitalization/statistics & numerical data
* Humans
* Infant
* Infant, Newborn
* L-Lactate Dehydrogenase/analysis*
* Logistic Models
* Male
* Multivariate Analysis
* Nasal Lavage Fluid/chemistry*
* Respiratory Syncytial Virus Infections/complications
* Respiratory Syncytial Virus Infections/metabolism
* Retrospective Studies
* Severity of Illness Index
Substances:
* Cytokines
* L-Lactate Dehydrogenase
Grant Support:
* N01 HV28184/HV/NHLBI NIH HHS/United States
* N01-AI-30039/AI/NIAID NIH HHS/United States
* P01 AI062885/AI/NIAID NIH HHS/United States
* T32 HD42977/HD/NICHD NIH HHS/United States
-
------