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Risk Factors for Developing Adenovirus-Associated Post-Infectious Bronchiolitis Obliterans
Oren Gordon1,2, Hadhud Mohamad3, Noa Guzner4
1Pediatric Infectious Unit, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Insights
Identifying risk factors for adenovirus (AdV)-associated bronchiolitis (AdV-B) progression to post-infectious bronchiolitis obliterans (PIBO) is crucial. Jewish ethnicity, lymphopenia, and consolidations are identified as key risk factors.
Area of Science:
- Pediatric Respiratory Medicine
- Infectious Diseases
- Epidemiology
Background:
- Risk factors for progression from adenovirus (AdV)-associated bronchiolitis (AdV-B) to post-infectious bronchiolitis obliterans (PIBO) are not well-established.
- Understanding these risk factors is essential for developing targeted interventions.
Purpose of the Study:
- To investigate the risk factors associated with the progression of AdV-B to PIBO in a multicenter cohort.
- To identify specific clinical and demographic characteristics that predict PIBO development.
Main Methods:
- A multicenter hospital-based analysis of children admitted with AdV-B between 2016-2022.
- A case-control study comparing AdV-PIBO patients (2005-2023) with AdV-B controls without progression.
- Multivariate logistic regression analysis was employed to identify independent risk factors.
Main Results:
- The incidence of AdV-B and AdV-PIBO admissions increased from 2016-2022.
- Jewish ethnicity (92% vs. 66%), oxygen supplementation (84% vs. 45%), noninvasive ventilation (20% vs. 4%), consolidations (44% vs. 19%), and lymphopenia (92% vs. 46%) were significantly more common in AdV-PIBO cases.
- A combination of Jewish ethnicity, lymphopenia, consolidations, and prolonged admission demonstrated high predictive values for AdV-PIBO.
Conclusions:
- The study identifies Jewish ethnicity, lymphopenia, and consolidations as significant risk factors for AdV-B progression to PIBO.
- These findings highlight the need for targeted preventive and management strategies for AdV-B.
- The association with Jewish ethnicity suggests a potential genetic predisposition to PIBO.
Background:
Risk factors for progression of adenovirus (AdV)-associated bronchiolitis (AdV-B) to post-infectious bronchiolitis obliterans (PIBO) are poorly defined. We aimed to investigate this in a multicenter cohort.
Methods:
A multicenter hospital-based analysis included children admitted with AdV-B in Jerusalem during 2016-2022. A case-control analysis included AdV-PIBO patients in Jerusalem during 2005-2023. Cases were compared to randomly assigned controls admitted with AdV-B without progression to AdV-PIBO. Multivariate analysis with logistic regression was used.
Results:
The annual incidence of AdV-B admissions and AdV-PIBO increased during 2016-2022, during which 1522 children were admitted with AdV-B and 8 developed AdV-PIBO (0.5%). Of 30 AdV-PIBO cases identified during 2005-2023, available data were compared for 25 of them (72% boys; mean age ± standard deviation 1.2 ± 0.8 years) and 139 controls (66% boys; mean age 1.0 ± 0.6 years, p = 0.5 for age). Jewish ethnicity was more common in the AdV-PIBO versus control group (92% vs. 66%, p = 0.009), as were oxygen supplementation (84% vs. 45%, p < 0.001), noninvasive ventilation (20% vs. 4%, p = 0.004), consolidations on chest X-ray (44% vs. 19%, p = 0.011), and lymphopenia (92% vs. 46%, p < 0.001). Combining Jewish ethnicity, lymphopenia, consolidations, and prolonged admission as independent risk factors yielded positive and negative predictive values of 68.8% and 90.5%, respectively.
Conclusion:
These findings emphasize the urgent need for targeted preventive and management strategies. The identification of Jewish ethnicity as a risk factor may imply a genetic contribution to Adv-PIBO risk.
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