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Published on: August 7, 2017
Bronchiolitis phenotypes identified by latent class analysis may influence the occurrence of respiratory sequelae
Laura Petrarca1, Raffaella Nenna1, Greta Di Mattia1
1Department of Maternal, Infantile, and Urological Sciences, "Sapienza" University of Rome, Rome, Italy.
Insights
Infants hospitalized with bronchiolitis can be categorized into three profiles. Severe bronchiolitis increases wheezing risk in the first four years, while high eosinophil counts indicate higher risk after seven years.
Area of Science:
- Pediatric Pulmonology
- Clinical Epidemiology
Background:
- Bronchiolitis heterogeneity suggests varying risks for respiratory issues.
- Identifying distinct clinical profiles in infants with bronchiolitis is crucial for predicting long-term outcomes.
Purpose of the Study:
- To determine if different infant bronchiolitis clinical profiles, identified by latent class analysis (LCA), correlate with varied risks of developing wheezing.
Main Methods:
- Prospective enrollment of 1312 infants hospitalized for bronchiolitis over 15 years.
- Latent class analysis (LCA) to identify distinct bronchiolitis phenotypes.
- Annual phone interviews for 7 years to track wheezing episodes; adjusted multivariate regression for risk analysis.
Main Results:
- Latent class analysis identified three profiles: moderate (65.5%), severe (6.1%), and high eosinophils (28.4%).
- About 50% of children experienced wheezing one year post-hospitalization across all profiles.
- Severe bronchiolitis showed a higher adjusted odds ratio (OR) for wheezing at 2, 3, and 4 years compared to the moderate profile.
- At 7 years, the high eosinophils profile had a higher adjusted OR (2.58) for wheezing than the severe profile (2.29).
Conclusions:
- Latent class analysis effectively differentiated bronchiolitis into moderate, severe, and high eosinophil profiles.
- The severe profile is associated with increased wheezing risk in the initial 4 years post-bronchiolitis.
- The high eosinophil profile demonstrates a higher risk of wheezing at the 7-year follow-up mark.
Background:
The heterogeneity of bronchiolitis may imply or reflect a different predisposition to respiratory sequelae.
Objective:
Our aim was to investigate whether, among infants hospitalized with bronchiolitis, different clinical profiles extracted by latent class analysis (LCA) are associated with different risks of wheezing.
Methods:
Over 15 consecutive epidemic seasons (2004-2019), we prospectively enrolled infants <1 year hospitalized for the first episode of bronchiolitis in a single tertiary hospital. A detailed clinical questionnaire was filled for each infant. LCA was applied to differentiate bronchiolitis phenotypes, and after hospital discharge, a phone interview was performed annually to record the presence of wheezing episodes. Adjusted multivariate regression analyses were run to investigate the risk of wheezing during 7 years follow-up according to clinical phenotypes.
Results:
LCA performed on 1312 infants resulted in a three-class model. Profile 1 (65.5%): moderate bronchiolitis; Profile 2 (6.1%): severe bronchiolitis; and Profile 3(28.4%): bronchiolitis infants with high eosinophils blood count. At 1 year of follow up, about 50% of children presented wheezing in each profile. Compared to Profile 1, the adjusted odds ratio (OR) of having wheezing episodes was significantly higher in Profile 2 at 2, 3, and 4 years of follow-up. At 7 years, Profile 3 had an adjusted OR = 2.58, higher than Profile 2 (adjusted OR = 2.29).
Conclusions:
LCA clearly identified a "moderate", "severe," and "high eosinophils blood count" bronchiolitis. During the first 4 years after bronchiolitis, the "severe" profile showed the higher risk of wheezing, but after 7 years this risk seems higher in the "high eosinophils blood count" group.
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