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Prediction of postinfectious bronchiolitis obliterans prognosis in children
Jae Hwa Jung1, Ga Eun Kim1, In Kyung Min2
1Department of Pediatrics, Brain Korea 21 PLUS Project for Medical Science, Severance Hospital, Institute of Allergy, Institute for Immunology and Immunological Diseases, Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Insights
Postinfectious bronchiolitis obliterans (PIBO) prognosis is linked to initial pulmonary function and inflammatory findings. A new nomogram using post-bronchodilator FEV1 and CT scans aids in predicting PIBO outcomes.
Area of Science:
- Pulmonology
- Respiratory Medicine
- Clinical Research
Background:
- Postinfectious bronchiolitis obliterans (PIBO) significantly impacts patient quality of life and can lead to severe complications.
- Identifying prognostic factors is crucial for managing PIBO patients effectively.
Purpose of the Study:
- To evaluate prognostic factors for PIBO using baseline clinical characteristics.
- To develop a prediction model for determining PIBO patient prognoses.
Main Methods:
- 47 PIBO patients were assessed using spirometry and impulse oscillometry, with follow-up for at least 1 year.
- Poor prognosis was defined by persistent respiratory symptoms (>1 year), multiple hospitalizations, or ICU admissions.
- A nomogram was created using post-bronchodilator FEV1 and chest CT findings of inflammatory bronchiolitis.
Main Results:
- 68.1% of patients had a good prognosis, while 31.9% had a poor prognosis.
- Poor prognosis was associated with lower spirometry values (FVC, FEV1, FEF25-75%) and more inflammatory findings on chest CT.
- The developed nomogram demonstrated a high predictive accuracy (AUC 84.6%).
Conclusions:
- Lower pulmonary function and increased inflammatory bronchiolitis on initial examination predict a poor prognosis in PIBO.
- The developed nomogram provides a simple and applicable tool for predicting PIBO prognosis at diagnosis.
Introduction:
The prognosis of postinfectious bronchiolitis obliterans (PIBO) has many implications, ranging between reduced quality of life and life-threatening complications. We evaluated the prognostic factors for PIBO using the baseline clinical characteristics of patients and built a prediction model for determining the prognoses of PIBO patients using the identified parameters.
Methods:
We included 47 PIBO patients who underwent spirometry and impulse oscillometry and followed them up for at least 1 year. A patient's prognosis was classified as poor if the patient experienced at least one of the following: persistent respiratory symptoms for more than 1 year, two or more instances of hospitalizations due to respiratory symptoms, or more than one intensive care unit admission.
Results:
The prognoses of 32/47 (68.1%) patients was good, while that of 15/47 (31.9%) was poor. Spirometry results showed significantly lower forced vital capacity (FVC), forced expiratory volume in the first second (FEV1 ), forced expiratory flow at 25%-75% of FVC, and post-bronchodilator (BD) FEV1 values in the poor prognosis group; chest computed tomography (CT) demonstrated more inflammatory bronchiolitis findings. We created a nomogram for predicting prognoses using post-BD FEV1 and inflammatory bronchiolitis on chest CT. The area under the curve for the nomogram was 84.6% (95% confidence interval: 72.8%-96.4%).
Conclusions:
PIBO patients with lower pulmonary function values and more findings of inflammatory bronchiolitis on initial examination have poor prognoses. The nomogram for predicting PIBO prognosis is easy to use and can be applied at the time of diagnosis.
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