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Eosinophil cationic protein in infants with respiratory syncytial virus bronchiolitis: predictive value for
M Pifferi1, V Ragazzo, D Caramella
1Department of Pediatrics, University of Pisa, Italy. m.pifferi@med.unipi.it
Insights
Elevated eosinophil cationic protein (ECP) levels in infants with respiratory syncytial virus (RSV) bronchiolitis can predict persistent wheezing. Higher serum ECP indicates a greater risk of developing long-term respiratory symptoms.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Infectious Diseases
Background:
- Infants with acute bronchiolitis face increased risk of persistent wheezing and asthma.
- Eosinophil cationic protein (ECP) involvement in respiratory syncytial virus (RSV) bronchiolitis suggests inflammatory mechanisms.
Purpose of the Study:
- To determine if serum ECP (s-ECP) measurements predict persistent wheezing in children with RSV bronchiolitis over a 5-year follow-up.
- To assess the utility of s-ECP as a predictive biomarker for late-onset respiratory symptoms.
Main Methods:
- Prospective enrollment of 48 infants diagnosed with acute RSV bronchiolitis.
- Measurement of peripheral eosinophil counts, serum ECP, and serum IgE during acute illness.
- Re-evaluation of respiratory symptoms and atopic status after 5 years using standardized questionnaires and specific IgE levels.
Main Results:
- Significantly higher s-ECP levels were observed in infants who developed persistent wheezing compared to those who did not (P < 0.001).
- Initial s-ECP values accurately predicted the development of persistent wheezing (P < 0.001).
- Infants with s-ECP levels ≥ 8 microg/L had a 9.73-fold higher risk of developing respiratory symptoms (P < 0.0001).
Conclusions:
- Serum ECP levels in infants hospitalized with bronchiolitis are a valuable predictor of persistent wheezing risk over the next 5 years.
- ECP may serve as a useful biomarker for identifying infants at high risk for developing chronic respiratory issues post-bronchiolitis.
Abstract:
Infants with acute bronchiolitis during the first months of life are at increased risk of developing persistent wheezing and bronchial asthma later in life. The study of eosinophil cationic protein (ECP) suggests that eosinophil-related inflammatory mechanisms may play a role in respiratory syncytial virus (RSV) bronchiolitis. The aim of our study was to verify whether serum ECP (s-ECP) measurements are useful in predicting the development of persistent wheezing in children affected by RSV bronchiolitis during a 5 years follow-up period. Forty-eight infants were enrolled prospectively (mean age: 153.5 days). All had a clinical and radiological diagnosis of acute bronchiolitis and confirmed RSV infection. Peripheral eosinophil counts, levels of s-ECP, and serum IgE concentrations were measured during bronchiolitis. Five years later the children were re-evaluated in regard to their respiratory symptoms (standardized questionnaires) and atopic status (specific IgE levels). We observed significantly higher s-ECP levels (P < 0.001) at enrollment in subjects who developed persistent wheezing compared to subjects who did not show late wheezing. Initial s-ECP values allowed significant and correct prediction of persistent wheezing (P < 0.001). The risk to develop respiratory symptoms was 9.73 higher for infants with s-ECP levels > or = 8 microg/L than for those with s-ECP levels <8 microg/L (P < 0.0001). In conclusion, our study suggests that s-ECP levels in infants with bronchiolitis are useful in predicting the risk to develop wheezing in the subsequent 5 years.