title: Lactate dehydrogenase and caspase activity in nasopharyngeal secretions are predictors of bronchiolitis severity.
abstract: BACKGROUND
  Bronchiolitis is the leading cause of hospitalization in infants. Biomarkers of disease severity might help in clinical management.
  
  
  OBJECTIVE
  To determine the clinical predictiveness of NW-LDH, NW-caspase 3/7, and NW-LDH/NW-caspase 3/7 ratio in bronchiolitis.
  
  
  METHODS
  Previously healthy children less than 24 months of age with bronchiolitis were recruited from the Texas Children's emergency room and intensive care unit from October 2010 to April 2011. Demographic, clinical information, and NW samples were obtained at enrollment. NW samples were analyzed for respiratory viruses, caspase 3/7, and LDH.
  
  
  RESULTS
  A viral pathogen was detected in 91·6% of 131 children, with the most common being respiratory syncytial virus and human rhinovirus. A single infection was found in 61·8% of subjects and co-infection in 29·8%. Children admitted to ICU had significantly higher NW-LDH than children sent home from the ER or admitted to the general floor (P = 0·02). Children infected with RSV had the highest NW-LDH concentration (P = 0·03) compared with other viral infections. NW-LDH and NW-caspase were significantly correlated (r = 0·77, P < 0·0001). The univariate models showed NW-LDH and NW-LDH/NW- caspase 3/7 ratio were directly associated with hospitalization. Mutivariate regression analyses suggested a complex interaction between the biomarkers, demographics, and disposition.
  
  
  CONCLUSIONS
  NW-LDH, NW-caspase 3/7 and NW-LDH/NW-caspase 3/7 ratio and their interactions with demographic factors are predictive of bronchiolitis severity and can help distinguish children requiring ICU-level care from those admitted to the general floor, or discharged home from the emergency center.
authors.affiliation: Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA.
authors.forename: Reena
authors.initials: R
authors.lastname: Mehta
authors.forename: Margaret
authors.initials: M
authors.lastname: Scheffler
authors.forename: Lorena
authors.initials: L
authors.lastname: Tapia
authors.forename: Letisha
authors.initials: L
authors.lastname: Aideyan
authors.forename: Kirtida D
authors.initials: KD
authors.lastname: Patel
authors.forename: Alan M
authors.initials: AM
authors.lastname: Jewell
authors.forename: Vasanthi
authors.initials: V
authors.lastname: Avadhanula
authors.forename: Minghua
authors.initials: M
authors.lastname: Mei
authors.forename: Roberto P
authors.initials: RP
authors.lastname: Garofalo
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Piedra
mesh_terms: D015415:Biomarkers / Q000032:analysis; D012634:Bodily Secretions / Q000201:enzymology*; D001988:Bronchiolitis / Q000175:diagnosis* / Q000473:pathology*; D020169:Caspases / Q000032:analysis*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007770:L-Lactate Dehydrogenase / Q000032:analysis*; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013781:Texas; D014777:Virus Diseases / Q000175:diagnosis* / Q000473:pathology*
chemical_list: D015415:Biomarkers; D007770:L-Lactate Dehydrogenase; D020169:Caspases
keywords: Bronchiolitis; caspase; disease severity; lactate dehydrogenase