OBJECTIVE: Because the decision to hospitalize an infant with bronchiolitis is often supported by subjective criteria and objective indicators of bronchiolitis severity are lacking, we tested the hypothesis that lactate dehydrogenase (LDH), which is released from injured cells, is a useful biochemical indicator of bronchiolitis severity.PATIENTS AND METHODS: We retrospectively analyzed a study of children 24 months old presenting to the emergency department with bronchiolitis. Demographic, clinical information, nasal wash (NW), and serum specimens were obtained. NW samples were analyzed for respiratory viruses, caspase 3/7 activity, and a panel of cytokines and chemokines. Total LDH activity was tested in NW samples and sera.RESULTS: Of 101 enrolled children (median age: 5.6 months), 98 had NW specimens available. A viral etiology was found for 82 patients (83.6%), with respiratory syncytial virus (RSV) (66%) and rhinovirus (19%) being the most common viruses detected. Concentrations of LDH in NW specimens were independent from those in sera and were higher in children with RSV infection or with dual infection. Significant correlations were found between NW LDH and NW cytokines/chemokines. Similarly, NW LDH correlated with NW-caspase 3/7 activity (r = 0.75; P .001). In a multivariate analysis, NW LDH concentration in the upper quartile was significantly associated with a reduced risk of hospitalization (odds ratio: 0.19 [95% confidence interval: 0.05–0.68]; P = .011).CONCLUSIONS: NW LDH levels in young children with bronchiolitis varied according to viral etiology and disease severity. Values in the upper quartile were associated with ～80% risk reduction in hospitalization, likely reflecting a robust antiviral response. NW LDH may be a useful biomarker to assist the clinician in the decision to hospitalize a child with bronchiolitis.
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机译：目的：由于主观标准通常支持婴儿毛细支气管炎住院的决定，而缺乏细支气管炎严重程度的客观指标，因此我们检验了从受损细胞释放的乳酸脱氢酶（LDH）是一种有用的生化指标毛细支气管炎的严重程度。患者与方法：我们回顾性分析了对24岁以下就诊于毛细支气管炎急诊科的儿童的研究。获得了人口统计学，临床信息，洗鼻液（NW）和血清标本。分析了NW样品的呼吸道病毒，胱天蛋白酶3/7活性以及一组细胞因子和趋化因子。结果：在101名登记的儿童（中位年龄：5.6个月）中，有98名NW样本可用。发现的病毒病因为82例患者（83.6％），其中呼吸道合胞病毒（RSV）（66％）和鼻病毒（19％）是最常见的病毒。 NW标本中LDH的浓度与血清中的浓度无关，在RSV感染或双重感染的儿童中LDH的浓度较高。 NW LDH与NW细胞因子/趋化因子之间存在显着相关性。同样，NW LDH与Nw-caspase 3/7活性相关（r = 0.75; P <.001）。在多变量分析中，上四分位数的NW LDH浓度与住院风险降低显着相关（优势比：0.19 [95％置信区间：0.05-0.68]; P = 0.011）。结论：年轻时NW LDH水平细支气管炎患儿根据病毒病因和疾病严重程度而异。上四分位数的值与住院风险降低约80％相关，可能反映了强劲的抗病毒反应。 NW LDH可能是有用的生物标志物，可帮助临床医生决定将儿童毛细支气管炎住院。
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