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Serum eosinophil cationic protein as a predictor of wheezing after bronchiolitis
T M Reijonen1, M Korppi, L Kuikka
1Department of Pediatrics, Kuopio University Hospital, Finland.
Insights
High serum eosinophil cationic protein (ECP) levels in infants with bronchiolitis predict subsequent wheezing episodes. ECP is a specific but insensitive marker for predicting post-bronchiolitis wheezing in children.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Biomarkers in Childhood Disease
Background:
- Bronchiolitis is a common viral respiratory infection in infants.
- Wheezing after bronchiolitis is a significant concern in early childhood.
- Identifying predictors of post-bronchiolitis wheezing is crucial for early intervention.
Purpose of the Study:
- To evaluate serum eosinophil cationic protein (ECP) concentrations as a predictor of wheezing after bronchiolitis.
- To assess the correlation between ECP levels and subsequent wheezing episodes and hospital admissions.
- To determine if anti-inflammatory therapy influences ECP levels or wheezing outcomes.
Main Methods:
- Prospective study of 92 infants under 2 years admitted for acute bronchiolitis.
- Serum ECP levels measured on admission, 6, and 16 weeks post-hospitalization.
- Patients received cromolyn sodium, budesonide, or no therapy for 16 weeks; wheezing episodes and admissions were recorded.
Main Results:
- Infants with high serum ECP (> or = 16 µg/L) at admission had significantly more wheezing episodes (86% vs 43%) and hospital admissions (64% vs 19%) during follow-up.
- A threshold of ECP > or = 8 µg/L also showed significant association with increased wheezing.
- Serum ECP levels decreased over time and did not differ between treatment groups.
Conclusions:
- Elevated serum ECP during acute bronchiolitis is a specific but insensitive predictor of subsequent wheezing.
- ECP may serve as a useful biomarker for identifying infants at higher risk for persistent wheezing.
- Therapeutic interventions did not significantly alter ECP levels or impact wheezing outcomes in this study.
Abstract:
We have evaluated the role of eosinophil cationic protein (ECP) concentrations in serum in predicting wheezing after bronchiolitis, during infancy and early childhood. A prospective study at a university hospital serving all pediatric patients in a defined area was designed. Serum ECP concentrations were measured in 92 infants under the age of 2 years on admission for acute bronchiolitis, and 6 and 16 weeks after hospitalization. Nebulized anti-inflammatory therapy was initiated during hospitalization: 32 patients received cromolyn sodium and 32 patients received budesonide for 16 weeks; 30 control patients received no maintenance therapy. The numbers of subsequent physician-diagnosed wheezing episodes and hospital admissions for obstructive airway disease were recorded during 16 weeks of follow-up. At entry, 14 of 92 (15%) children had high (> or = 16 micrograms/L) levels of ECP in their serum. During the 16-week follow-up period, this group of patients had significantly more physician-diagnosed episodes of wheezing (86% vs. 43%, P < 0.01) and hospital admissions for wheezing (64% vs. 19%, P = 0.001) than those with serum levels of ECP < 16 micrograms/L. The number of patients with serum ECP > or = 8 micrograms/L was 25 (27%); 76% of this group developed physician-diagnosed wheezing (P < 0.01), and 48% had hospital admissions for wheezing (P < 0.01). Serum ECP levels decreased significantly with respect to time after bronchiolitis and did not differ among the three intervention groups. We conclude that a high serum ECP concentration during the acute phase of bronchiolitis is a specific but insensitive predictor of wheezing after bronchiolitis.