RESUMEN
Bronchiolitis is one of the leading causes of hospitalisation in infancy, with highly variable clinical presentations ranging from mild disease safely managed at home to severe disease requiring invasive respiratory support. Identifying immune biomarkers that can predict and stratify this variable disease severity has important implications for clinical prognostication/disposition. A systematic literature search of the databases Embase, PubMed, ScienceDirect, Web of Science, and Wiley Online Library was performed. English language studies that assessed the association between an immune biomarker and bronchiolitis disease severity among children aged less than 24â¯months were included. 252 distinct biomarkers were identified across 90 studies. A substantial degree of heterogeneity was observed in the bronchiolitis definitions, measures of disease severity, and study designs. 99 biomarkers showed some significant association with disease severity, but only 18 were significant in multiple studies. However, all of these candidate biomarkers had comparable studies that reported conflicting results. Conclusion: The heterogeneity among included studies and the lack of a consistently significant biomarker highlight the need for consensus on bronchiolitis definitions and severity measures, as well as further studies assessing their clinical utility both in isolation and in combination.
Asunto(s)
Bronquiolitis Viral/inmunología , Citocinas/inmunología , Receptores de Citocinas/inmunología , Infecciones por Virus Sincitial Respiratorio/inmunología , Células Presentadoras de Antígenos/inmunología , Biomarcadores , Quimiocinas/inmunología , Citocinas/genética , Humanos , Lactante , Recién Nacido , Leucocitos/inmunología , Linfocitos/inmunología , Polimorfismo Genético , Receptores de Quimiocina/inmunología , Índice de Severidad de la Enfermedad , Receptores Toll-Like/genéticaAsunto(s)
Neuroimagen , Tubulina (Proteína) , Humanos , Lactante , Fenotipo , Mutación , Tubulina (Proteína)/genéticaRESUMEN
Viral bronchiolitis is one of the most common hospital presentations in infancy and as such represents a major healthcare burden worldwide. However despite this, there are currently no effective targeted therapies nor can those infants at highest risk for developing severe disease or subsequent respiratory morbidity be predicted on initial hospital presentation. Current definitions of bronchiolitis in the published literature vary significantly in terms of the age range at presentation, specific clinical symptoms, causative virus, and the inclusion or exclusion of infants with previous presentations and/or various comorbidities. In this review, we highlight how this heterogeneity among definitions contributes to a lack of clarity on this condition and its likely multiple endotypes. We argue that without a new universal consensus definition or sets of definitions, progress into bronchiolitis will continue to be stalled.