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2013 ; 48
(5
): 456-63
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Clinical risk factors are more relevant than respiratory viruses in predicting
bronchiolitis severity
#MMPMID22949404
Ricart S
; Marcos MA
; Sarda M
; Anton A
; Muñoz-Almagro C
; Pumarola T
; Pons M
; Garcia-Garcia JJ
Pediatr Pulmonol
2013[May]; 48
(5
): 456-63
PMID22949404
show ga
BACKGROUND: The role of respiratory viruses in the pathogenesis of bronchiolitis
was re-evaluated with the use of molecular methods such as PCR for virus
detection. Whether specific viruses or the classical clinical risk factors are
more important in determining severe bronchiolitis is not well established. AIM:
To analyze the specific viruses and clinical variables that can predict severe
bronchiolitis at admission. METHODS: Nasopharyngeal aspirates were prospectively
collected from 484 children <12 months admitted to the pediatrics ward or PICU at
Universitary Hospital Sant Joan de Déu (Barcelona, Spain) for bronchiolitis from
October 2007 to October 2008. Clinical and demographic data were collected.
Sixteen respiratory viruses were studied using PCR. Severity was assessed with a
bronchiolitis clinical score (BCS). RESULTS: Four hundred ten infants that tested
positive for respiratory viruses were analyzed. Mixed viral infections did not
increase the severity of the disease. Rhinovirus was associated with severe BCS
in univariate analysis (P = 0.041), but in the multivariate logistic regression
including viruses and clinical data only bronchopulmonary dysplasia (OR 7.2; 95%
CI 1.2-43.3), congenital heart disease (OR 4.7; 95% CI 1.1-19.9), prematurity (OR
2.6; 95% CI 1.3-5.1), and fever (OR 1.8, 95% CI 1.1-3.1) showed statistical
significance for predicting severe BCS. CONCLUSIONS: Classical clinical risk
factors have more weight in predicting a severe BCS in infants with acute
bronchiolitis than the involved viruses.