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Published on: November 10, 2023
Risk Factors for the Development of Post-Infectious Bronchiolitis Obliterans in Children: A Systematic Review and
Eun Lee1, Suyeon Park2,3, Kyunghoon Kim4,5
1Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 61469, Korea.
Insights
Post-infectious bronchiolitis obliterans (PIBO) is often underdiagnosed. Key risk factors for PIBO in children include elevated lactate dehydrogenase, pleural effusion, hypoxemia, sex, and mechanical ventilation.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Critical Care Medicine
Background:
- Post-infectious bronchiolitis obliterans (PIBO) is a serious complication of respiratory infections, frequently underdiagnosed.
- Identifying children at risk for PIBO is crucial for timely diagnosis and management.
Purpose of the Study:
- To systematically identify and analyze risk factors associated with the development of PIBO in children.
- To provide evidence for improved diagnostic strategies and targeted management of high-risk pediatric patients.
Main Methods:
- A comprehensive meta-analysis was conducted, searching PubMed, Embase, and MEDLINE databases up to June 13, 2022.
- Seven studies involving 344 children with PIBO and 1310 controls were included, analyzing 22 potential risk variables.
- Fixed-effect and random-effect models were employed to assess odds ratios, hazard ratios, and relative risks.
Main Results:
- Significant risk factors identified across multiple studies include elevated lactate dehydrogenase, pleural effusion, hypoxemia, sex, and mechanical ventilation.
- The impact of hospitalization duration and fever varied based on statistical methods and specific respiratory pathogens.
- Risk factor profiles differed depending on the causative respiratory infection pathogens.
Conclusions:
- This meta-analysis pinpoints key risk factors that can aid in the early identification of children susceptible to PIBO.
- Findings underscore the necessity of avoiding misdiagnosis and developing targeted management strategies for PIBO prevention and treatment.
Abstract:
Post-infectious bronchiolitis obliterans (PIBO), one of the major complications of respiratory tract infection, is commonly underdiagnosed. To identify the risk groups that may develop PIBO and avoid misdiagnoses, we investigated the risk factors associated with the development of PIBO. We searched PubMed, Embase, and MEDLINE databases for studies that included risk factors for the development of PIBO published from inception to 13 June 2022. We limited our search to studies that reported the estimates of odds ratio (OR), hazard ratio (HR), or relative risks for developing PIBO. A fixed-effect and a random-effect model were used. We included seven studies reporting data on the risk factors for PIBO in 344 children with PIBO and 1310 control children. Twenty-two variables, including sex, age, respiratory pathogens, symptoms, laboratory and radiologic findings, and mechanical ventilation, were mentioned in at least one study. The significant risk factors mentioned in two or more studies included elevated lactate dehydrogenase levels, pleural effusion, hypoxemia, sex, and mechanical ventilation. The significance of the duration of hospitalization and fever as risk factors for PIBO differed when the studies were classified according to the statistical method. In addition, the risk factors differed according to respiratory infection pathogens. This meta-analysis identified potential risk factors associated with the development of PIBO. The results of this study highlight the importance of avoiding misdiagnosis and help establish management strategies for patients at a high risk of developing PIBO.
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