A clustering approach to identify severe bronchiolitis profiles in children.
A clustering approach to identify severe bronchiolitis profiles in children.
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DOI：
10.1136/thoraxjnl-2016-208535
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发表时间：
2016-08
期刊：
影响因子：
10
通讯作者：
Camargo CA Jr
中科院分区：
文献类型：
--
作者：
Dumas O;Mansbach JM;Jartti T;Hasegawa K;Sullivan AF;Piedra PA;Camargo CA Jr
尽管细支气管炎通常被认为是一种单一疾病，但最近的研究表明存在异质性。我们的目的是使用聚类方法来识别严重细支气管炎的特征。我们分析了两组因细支气管炎住院的 2 岁以下儿童的前瞻性、多中心队列的数据，一组在美国（2007-2010 年冬季，n=2,207），另一组在芬兰（2008-2010 年冬季，n=408）。严重细支气管炎的情况是通过潜在类别分析确定的，根据临床因素和病毒病因对儿童进行分类。在美国的研究中，确定了四种情况。 A型（12%）的特点是有喘息和湿疹病史、就诊时出现喘息以及鼻病毒感染。 B 型 (36%) 包括在急诊科就诊时出现喘息的儿童，但与 A 型相反，大多数儿童没有喘息或湿疹病史；该特征具有最大的 RSV 感染概率。 C型（34%）是病情最严重的组，住院时间较长，有中度至重度回缩。 D 型（17%）的病情最轻，包括住院时间较短的无喘息儿童。其中两个特征（A 和 D）在芬兰队列中得到了复制；第三组（“BC”）包括具有美国人口中 B 和/或 C 特征的芬兰儿童。在两项针对因细支气管炎住院儿童的多中心研究中，通过聚类方法确定了几种不同的临床特征（表型）。观察到的异质性对于细支气管炎的病因学、治疗和长期结果（例如儿童哮喘的未来风险）的未来研究具有重要意义。
Although bronchiolitis is generally considered a single disease, recent studies suggest heterogeneity. We aimed to identify severe bronchiolitis profiles using a clustering approach. We analyzed data from two prospective, multi-center cohorts of children younger than 2 years hospitalized with bronchiolitis, one in the U.S. (2007–2010 winter seasons, n=2,207) and one in Finland (2008–2010 winter seasons, n=408). Severe bronchiolitis profiles were determined by latent class analysis, classifying children based on clinical factors and viral etiology. In the U.S. study, four profiles were identified. Profile A (12%) was characterized by history of wheezing and eczema, wheezing at the ED presentation and rhinovirus infection. Profile B (36%) included children with wheezing at the ED presentation, but, in contrast to profile A, most did not have history of wheezing or eczema; this profile had the largest probability of RSV-infection. Profile C (34%) was the most severely ill group, with longer hospital stay and moderate-to-severe retractions. Profile D (17%) had the least severe illness, including non-wheezing children with shorter length-of-stay. Two of these profiles (A and D) were replicated in the Finnish cohort; a third group (“BC”) included Finnish children with characteristics of profiles B and/or C in the U.S. population. Several distinct clinical profiles (phenotypes) were identified by a clustering approach in two multicenter studies of children hospitalized for bronchiolitis. The observed heterogeneity has important implications for future research on the etiology, management and long-term outcomes of bronchiolitis, such as future risk of childhood asthma.
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影响因子：
3.6
作者：
Schroeder AR;Mansbach JM
通讯作者：
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DOI：
10.1016/j.jaci.2014.07.001
发表时间：
2015-03
期刊：
The Journal of allergy and clinical immunology
影响因子：
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作者：
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作者：
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