Gordon Oren, Mohamad Hadhud, Guzner Noa, Cohen Yuval, Ben-Meir Elad, Samman Nahla, Sergienko Ruslan, Wolf Dana G, Picard Elie, Kerem Eitan, Shamriz Oded
Pediatric Infectious Unit, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
The Goldyne Savad Institute of Gene Therapy, Hadassah Medical Center, Jerusalem, Israel.
Pediatr Pulmonol. 2025 Jan;60(1):e27411. doi: 10.1002/ppul.27411. Epub 2024 Nov 21.
Risk factors for progression of adenovirus (AdV)-associated bronchiolitis (AdV-B) to post-infectious bronchiolitis obliterans (PIBO) are poorly defined. We aimed to investigate this in a multicenter cohort.
A multicenter hospital-based analysis included children admitted with AdV-B in Jerusalem during 2016-2022. A case-control analysis included AdV-PIBO patients in Jerusalem during 2005-2023. Cases were compared to randomly assigned controls admitted with AdV-B without progression to AdV-PIBO. Multivariate analysis with logistic regression was used.
The annual incidence of AdV-B admissions and AdV-PIBO increased during 2016-2022, during which 1522 children were admitted with AdV-B and 8 developed AdV-PIBO (0.5%). Of 30 AdV-PIBO cases identified during 2005-2023, available data were compared for 25 of them (72% boys; mean age ± standard deviation 1.2 ± 0.8 years) and 139 controls (66% boys; mean age 1.0 ± 0.6 years, p = 0.5 for age). Jewish ethnicity was more common in the AdV-PIBO versus control group (92% vs. 66%, p = 0.009), as were oxygen supplementation (84% vs. 45%, p < 0.001), noninvasive ventilation (20% vs. 4%, p = 0.004), consolidations on chest X-ray (44% vs. 19%, p = 0.011), and lymphopenia (92% vs. 46%, p < 0.001). Combining Jewish ethnicity, lymphopenia, consolidations, and prolonged admission as independent risk factors yielded positive and negative predictive values of 68.8% and 90.5%, respectively.
These findings emphasize the urgent need for targeted preventive and management strategies. The identification of Jewish ethnicity as a risk factor may imply a genetic contribution to Adv-PIBO risk.
腺病毒（AdV）相关细支气管炎（AdV-B）进展为感染后闭塞性细支气管炎（PIBO）的危险因素尚不明确。我们旨在通过一项多中心队列研究对此进行调查。
一项基于多中心医院的分析纳入了2016年至2022年期间在耶路撒冷因AdV-B入院的儿童。一项病例对照分析纳入了2005年至2023年期间在耶路撒冷的AdV-PIBO患者。将病例与随机分配的因AdV-B入院但未进展为AdV-PIBO的对照进行比较。采用逻辑回归进行多变量分析。
2016年至2022年期间，AdV-B入院和AdV-PIBO的年发病率有所上升，在此期间，1522名儿童因AdV-B入院，8例发展为AdV-PIBO（0.5%）。在2005年至2023年期间确诊的30例AdV-PIBO病例中，对其中25例（72%为男孩；平均年龄±标准差1.2±0.8岁）和139例对照（66%为男孩；平均年龄1.0±0.6岁，年龄p = 0.5）的可用数据进行了比较。AdV-PIBO组中犹太族裔比对照组更常见（92%对66%，p = 0.009），吸氧情况（84%对45%，p < 0.001）、无创通气（20%对4%，p = 0.004）、胸部X线显示实变（44%对19%，p = 0.011）以及淋巴细胞减少（92%对46%，p < 0.001）也是如此。将犹太族裔、淋巴细胞减少、实变和延长住院时间作为独立危险因素综合分析，阳性预测值和阴性预测值分别为68.8%和90.5%。
这些发现强调了迫切需要有针对性的预防和管理策略。将犹太族裔确定为危险因素可能意味着其对AdV-PIBO风险有遗传影响。
