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Chronic aspiration in children: evaluation of the lipid-laden macrophage index
1Department of Pediatrics, Section of Pulmonology, Children's Mercy Hospital, Kansas City, Missouri 64108, USA. mbauer@cmh.edu
Abstract:
Chronic pulmonary aspiration (CPA) causes significant morbidity, but is underdiagnosed because of difficulties in establishing a diagnosis. The lipid-laden macrophage index (LLMI) is said to differentiate between those with and without CPA. Records of 113 patients were reviewed to determine specificity and sensitivity of the LLMI for CPA. Diagnostic accuracy was inferred from treatment outcome. Mean LLMI for aspirators was 104 +/- 62 (range, 20-233), and for nonaspirators, 44 +/- 39 (range, 0-170) (P < 0.05). Sensitivity and specificity were 0.69 and 0.79, respectively. While the LLMI provides clinically helpful information, it does not stand alone as the gold standard for the diagnosis of CPA. Failure to thrive and neurological impairment correlated with CPA, using Fisher's exact test. CPA was not diagnosed in any patient with normal growth, normal neurological development, and an LLMI <86. No other clinical observation (cough, wheeze, vomiting, difficulty feeding, choking with feeding, recurrent pneumonia, bronchopulmonary dysplasia, chronic chest X-ray changes, endotracheal tube, tracheostomy tube, nasogastric feeding tube, or transpyloric feeding tube) or diagnostic study (upper gastrointestinal series, gastroesophageal scintigraphy, modified barium swallow, or pH probe) correlated with the diagnosis of CPA.
Insights
The lipid-laden macrophage index (LLMI) offers helpful data for diagnosing chronic pulmonary aspiration (CPA). However, it is not a definitive standalone test for CPA diagnosis.
Area of Science:
- Pulmonology
- Pediatric Gastroenterology
Background:
- Chronic pulmonary aspiration (CPA) is a significant cause of morbidity.
- Diagnosis of CPA is challenging due to difficulties in establishing definitive evidence.
Purpose of the Study:
- To determine the sensitivity and specificity of the lipid-laden macrophage index (LLMI) in diagnosing CPA.
- To evaluate the diagnostic accuracy of LLMI for CPA.
Main Methods:
- Retrospective review of 113 patient records.
- Analysis of LLMI values in patients with and without CPA.
- Diagnostic accuracy inferred from treatment outcomes.
- Fisher's exact test used to correlate clinical factors with CPA.
Main Results:
- Mean LLMI was significantly higher in aspirators (104 +/- 62) than non-aspirators (44 +/- 39).
- LLMI demonstrated a sensitivity of 0.69 and specificity of 0.79 for CPA.
- Failure to thrive and neurological impairment correlated with CPA.
- No CPA diagnosis occurred in patients with normal growth, neurological development, and LLMI <86.
Conclusions:
- The LLMI provides valuable information but is not the sole gold standard for CPA diagnosis.
- LLMI, combined with normal growth and neurological development, can help rule out CPA.
- Clinical observations and other diagnostic studies showed no significant correlation with CPA diagnosis in this cohort.