LDH concentration in nasal-wash fluid as a biochemical predictor of bronchiolitis severity

Federico R. Laham, Amanda A. Trott, Berkeley L. Bennett, Claudia A. Kozinetz, Alan M. Jewell, Roberto Garofalo, Pedro A. Piedra

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

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 ∼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.

Original languageEnglish (US)
JournalPediatrics
Volume125
Issue number2
DOIs
StatePublished - Feb 2010

Fingerprint

Bronchiolitis
L-Lactate Dehydrogenase
Nose
Caspase 7
Chemokines
Caspase 3
Hospitalization
Serum
Cytokines
Viruses
Respiratory Syncytial Virus Infections
Rhinovirus
Respiratory Syncytial Viruses
Virus Diseases
Risk Reduction Behavior
Antiviral Agents
Hospital Emergency Service
Multivariate Analysis
Biomarkers
Odds Ratio

Keywords

  • Biochemical marker
  • Bronchiolitis
  • Hospitalization
  • LDH
  • Respiratory syncytial virus

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Laham, F. R., Trott, A. A., Bennett, B. L., Kozinetz, C. A., Jewell, A. M., Garofalo, R., & Piedra, P. A. (2010). LDH concentration in nasal-wash fluid as a biochemical predictor of bronchiolitis severity. Pediatrics, 125(2). https://doi.org/10.1542/peds.2009-0411

LDH concentration in nasal-wash fluid as a biochemical predictor of bronchiolitis severity. / Laham, Federico R.; Trott, Amanda A.; Bennett, Berkeley L.; Kozinetz, Claudia A.; Jewell, Alan M.; Garofalo, Roberto; Piedra, Pedro A.

In: Pediatrics, Vol. 125, No. 2, 02.2010.

Research output: Contribution to journalArticle

Laham, FR, Trott, AA, Bennett, BL, Kozinetz, CA, Jewell, AM, Garofalo, R & Piedra, PA 2010, 'LDH concentration in nasal-wash fluid as a biochemical predictor of bronchiolitis severity', Pediatrics, vol. 125, no. 2. https://doi.org/10.1542/peds.2009-0411
Laham, Federico R. ; Trott, Amanda A. ; Bennett, Berkeley L. ; Kozinetz, Claudia A. ; Jewell, Alan M. ; Garofalo, Roberto ; Piedra, Pedro A. / LDH concentration in nasal-wash fluid as a biochemical predictor of bronchiolitis severity. In: Pediatrics. 2010 ; Vol. 125, No. 2.
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abstract = "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 ∼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.",
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AU - Laham, Federico R.

AU - Trott, Amanda A.

AU - Bennett, Berkeley L.

AU - Kozinetz, Claudia A.

AU - Jewell, Alan M.

AU - Garofalo, Roberto

AU - Piedra, Pedro A.

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AB - 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 ∼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.

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KW - Bronchiolitis

KW - Hospitalization

KW - LDH

KW - Respiratory syncytial virus

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