Key result
Nasal wash lactate dehydrogenase (NW-LDH) levels were significantly higher in children admitted to the ICU compared to those discharged from the ER or admitted to the general floor (P=0.02).
Why the study?
Do nasal wash LDH and caspase 3/7 levels predict bronchiolitis severity in previously healthy children under 24 months of age?
Observational (n=131)
No
Do nasal wash LDH and caspase 3/7 levels predict bronchiolitis severity in previously healthy children under 24 months of age?
p-value: p=0.02
Nasal wash LDH and caspase 3/7 levels are predictive of bronchiolitis severity and may help triage infants requiring ICU-level care.
NW-LDH elevation was associated with ICU admission in bronchiolitis; hypothesis-generating for severity prediction before clinical adoption.
BACKGROUND: Bronchiolitis is the leading cause of hospitalization in infants. Biomarkers of disease severity might help in clinical management. OBJECTIVE: To determine the clinical predictiveness of NW-LDH, NW-caspase 3/7, and NW-LDH/NW-caspase 3/7 ratio in bronchiolitis. METHODS: Previously 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. RESULTS: A 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. CONCLUSIONS: NW-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.
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Mehta et al. (2014) conducted an observational in Bronchiolitis (n=131). Nasal wash lactate dehydrogenase (NW-LDH) and caspase 3/7 levels vs. Lower levels was evaluated on ICU admission (p=0.02). Nasal wash lactate dehydrogenase (NW-LDH) levels were significantly higher in children admitted to the ICU compared to those discharged from the ER or admitted to the general floor (P=0.02).
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