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Lipid-Laden Macrophage Index as a Diagnostic Tool for Pediatric Aspiration: A Systematic Review
Claire M Lawlor1, Sukgi S Choi2
1Department of Otolaryngology Children's National Health System Washington District of Columbia USA.
Objective:
Lipid-laden macrophage index (LLMI) has been proposed as a marker for aspiration on bronchoalveolar lavage. It has also been studied as a marker for gastroesophageal reflux and other pulmonary diseases. This review aims to determine the clinical correlation between LLMI and pediatric aspiration.
Data Sources:
PubMed (MeSH search), Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) portals through December 17th, 2020.
Review Methods:
Preferred Reporting Items for Systematic Review and Meta-Analysis criteria were followed, and a quality assessment of included studies was performed using the Methodological Index for Non-Randomized Studies. Search criteria included all occurrences in the title or abstract of the terms "pulmonary aspiration" and "alveolar macrophages."
Results:
Five studies describing 720 patients met inclusion, 3 retrospective case-control studies, and 2 prospective observational studies. Four studies suggested a link between elevated LLMI and aspiration, and 1 found no association. Control groups varied and included healthy nonaspirators to nonaspirators with other pulmonary diseases. Diagnosis of aspiration was not standardized across the studies. Three papers proposed cutoff values for LLMI, all different.
Conclusion:
The existing literature indicates that LLMI is not a sensitive or specific marker for aspiration. Further study is needed to define the utility of LLMI in pediatric aspiration.
Insights
The lipid-laden macrophage index (LLMI) is not a reliable marker for diagnosing pediatric aspiration. More research is needed to determine its clinical usefulness in identifying aspiration in children.
Area of Science:
- Pulmonology
- Pediatric Medicine
- Diagnostic Markers
Background:
- The lipid-laden macrophage index (LLMI) has been investigated as a potential biomarker.
- Its utility has been explored for diagnosing aspiration, gastroesophageal reflux, and other lung conditions.
Purpose of the Study:
- To review and synthesize the existing literature.
- To determine the clinical correlation between LLMI and pediatric aspiration.
Main Methods:
- Systematic review following PRISMA guidelines.
- Searches conducted in PubMed, Scopus, and CENTRAL databases up to December 2020.
- Quality assessment using the Methodological Index for Non-Randomized Studies.
Main Results:
- Five studies (720 patients) were included: 3 retrospective and 2 prospective.
- Four studies suggested a link between elevated LLMI and aspiration; one found no association.
- Inconsistent control groups, non-standardized aspiration diagnoses, and differing proposed LLMI cutoffs were noted.
Conclusions:
- Current evidence suggests LLMI lacks sensitivity and specificity as a marker for aspiration.
- Further research is required to establish the definitive role of LLMI in pediatric aspiration diagnosis.
