Serum Biomarkers Predicting Airway Remodeling in Severe Childhood Bronchial Asthma

To analyze the relationship between serum Toll-like receptor 4 (TLR4) and soluble intercellular adhesion molecule-1 (sICAM-1) levels and airway remodeling in children with severe bronchial asthma (BA) and their predictive value for recurrence.

A retrospective study was conducted to select the clinical data of 120 children with severe BA who were admitted to Northern Jiangsu People's Hospital from June 2022 to June 2023 and completed follow-up. Serum TLR4 and sICAM-1 were detected at admission. According to the recurrence during the follow-up period, the clinical data of the recurrent children were included in the recurrent group, and the clinical data of the non-recurrent children were included in the non-recurrent group. There were 55 children each in the recurrence group and the non-recurrence group. The baseline data of children with severe BA were statistically analyzed and compared. The correlation between serum TLR4 and sICAM-1 levels and airway remodeling in children with severe BA was analyzed by bivariate correlation Pearson (N). Binary logistic regression was used to analyze the relationship between serum TLR4, sICAM-1 levels, and recurrence in children with severe BA. Receiver operating characteristic curve (ROC) was used to analyze the predictive value of serum TLR4 and sICAM-1 for recurrence in children with severe BA; R4.1.0 statistical software was used to draw the decision curve of serum TLR4 and sICAM-1 levels to predict the recurrence of severe BA in children with a high-risk threshold as abscissa and net return rate as ordinate.

Among the 120 children with severe BA, 46 cases recurred during the 1-year follow-up period, with a recurrence rate of 38.33 %. The proportion of premature delivery and children with allergic rhinitis in the recurrent group was higher than that in the non-recurrent group, and the levels of eosinophil count, TLR4, and sICAM-1 were higher than those in the non-recurrent group (P < .001). The levels of T/D and WA% in the recurrent group were higher than those in the non-recurrent group (P < .001). The results of bivariate correlation Pearson (N) analysis showed that serum TLR4 and sICAM-1 levels were positively correlated with T/D and WA% in children with severe BA (r >0, P < .001); the results of ROC curve showed that the AUC of serum TLR4, sICAM-1 and combined detection in predicting the recurrence of children with severe BA were all > 0.70, which had certain predictive value, and the combined detection was the highest. The decision curve was drawn. The results showed that the net rate of return of serum TLR4 and sICAM-1 in predicting the recurrence of children with severe BA was better than that of a single net rate of return in the range of 0.217~0.284 and 0.296~0.492. In the range of high-risk threshold 0.000-0.958, the net rate of return of serum TLR4 and sICAM-1 combined to predict the recurrence of severe BA children was > 0, which was of clinical significance.

The serum TLR4 and sICAM-1 levels are closely related to airway remodeling and recurrence in children with severe BA, and their levels can effectively predict the risk of recurrence.