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Author Spotlight: Investigating the Key Factors of Obliterative Bronchiolitis After Lung Transplantation
Published on: November 10, 2023
Risk Factors for Post-infectious Bronchiolitis Obliterans in Children: A Systematic Review and Meta-Analysis
Die Liu1, Jing Liu1,2, Lipeng Zhang1,2
1Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China.
Insights
The strongest risk factors for post-infectious bronchiolitis obliterans (PIBO) are hypoxemia and mechanical ventilation. Other significant factors include tachypnea, wheezing, and specific medical treatments or conditions in children.
Area of Science:
- Pediatric Pulmonology
- Critical Care Medicine
- Infectious Diseases
Background:
- Post-infectious bronchiolitis obliterans (PIBO) is a serious long-term complication following lower respiratory tract infections.
- Identifying high-risk factors for PIBO is crucial for developing effective therapeutic strategies and improving patient outcomes.
Approach:
- A systematic review and meta-analysis was conducted using data from multiple online databases (PubMed, Embase, Web of Science, etc.).
- Included studies were observational and case-control designs providing data on potential PIBO risk factors.
- Pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated to assess risk factor associations.
Key Points:
- Hypoxemia (OR 21.54) and mechanical ventilation (OR 14.61) were identified as the most significant risk factors for PIBO.
- Other prominent risk factors include tachypnea, wheezing, γ-globulin use, glucocorticoid use, bacterial co-infection, a history of wheezing, and male sex.
- Children with PIBO were younger and had higher LDH levels and longer hospitalization durations.
Conclusions:
- Hypoxemia, mechanical ventilation, tachypnea, and wheezing are the primary risk factors for developing PIBO.
- Glucocorticoid use, γ-globulin use, bacterial co-infection, prior wheezing, and male sex also contribute to PIBO risk.
- These identified factors can aid in creating a clinical prediction model for PIBO in pediatric populations.
Background:
Post-infectious bronchiolitis obliterans (PIBO) is a long-term sequela after an initial insult to the lower respiratory tract. A comprehensive understanding of the factors that contribute to a high risk of developing PIBO is important to help define therapeutic strategies and improve prognosis.
Methods:
We performed a systematic review of published literature available in the online databases including PubMed, Embase, Web of Science, CNKI, Wan Fang, and VIP, with the last search updated on 27 January 2022. Observational studies and case-control studies that provide sufficient data to examine associations between potential risk factors and PIBO were included. Pooled odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) and heterogeneity were calculated.
Results:
A total of 14 risk factors were selected from 9 studies included in the analysis. The strongest risk factors were hypoxemia, mechanical ventilation, tachypnea, and wheezing. Hypoxemia conferred the greatest risk with pooled OR of 21.54 (95% CI: 10-46.36, p < 0.001). Mechanical ventilation ranked second (pooled OR 14.61, 95% CI: 7.53-28.35, p < 0.001). Use of γ-globulin, use of glucocorticoids, co-infection of bacteria, a history of wheezing, and being male were other prominent risk factors. The effects of premature birth, allergic rhinitis, and imaging finding (pulmonary consolidation, atelectasis, pleural effusion) are less clear and require further confirmation. Cases that developing PIBO had a lower age compared with controls (MD, -8.76 months, 95% CI: -16.50 to -1.02, p = 0.03). No significant differences were observed in the duration of fever (MD, 1.74 days, 95% CI: -0.07 to 3.54, p = 0.06). Children diagnosed with PIBO had higher LDH levels (MD, 264.69 U/L, 95% CI: 67.43 to 461.74, p = 0.008) and duration of hospitalization (MD, 4.50 days, 95% CI: 2.63 to 6.37, p < 0.001).
Conclusion:
In this study, we found that the strongest risk factors for PIBO were hypoxemia, mechanical ventilation, tachypnea, and wheezing. Use of glucocorticoids, γ-globulin, co-infection of bacteria, a history of wheezing, and being male may also play a role. The factors discussed above can inform the generation of a clinical prediction model for the developing PIBO in children.
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