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A clustering approach to identify severe bronchiolitis profiles in children
  1. Orianne Dumas1,2,3,4,
  2. Jonathan M Mansbach2,5,
  3. Tuomas Jartti6,
  4. Kohei Hasegawa1,2,
  5. Ashley F Sullivan1,
  6. Pedro A Piedra7,
  7. Carlos A Camargo Jr1,2
  1. 1Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Harvard Medical School, Boston, Massachusetts, USA
  3. 3Inserm, VIMA, Aging and Chronic Diseases. Epidemiological and Public Health Approaches, U1168, Villejuif, France
  4. 4UMR-S 1168, University Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France
  5. 5Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
  6. 6Department of Pediatrics, Turku University Hospital, Turku, Finland
  7. 7Departments of Molecular Virology and Microbiology, and Pediatrics, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Orianne Dumas, Inserm UMRS 1168, VIMA, Aging and Chronic Diseases. Epidemiological and Public Health Approaches, 16, Avenue Paul Vaillant Couturier, Villejuif Cedex 94807, France; orianne.dumas{at}inserm.fr

Abstract

Objective Although bronchiolitis is generally considered a single disease, recent studies suggest heterogeneity. We aimed to identify severe bronchiolitis profiles using a clustering approach.

Methods We analysed data from two prospective, multicentre cohorts of children younger than 2 years hospitalised with bronchiolitis, one in the USA (2007–2010 winter seasons, n=2207) 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 aetiology.

Results In the US study, four profiles were identified. Profile A (12%) was characterised by history of wheezing and eczema, wheezing at the emergency department (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 respiratory syncytial virus 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 US population.

Conclusions Several distinct clinical profiles (phenotypes) were identified by a clustering approach in two multicentre studies of children hospitalised for bronchiolitis. The observed heterogeneity has important implications for future research on the aetiology, management and long-term outcomes of bronchiolitis, such as future risk of childhood asthma.

  • Respiratory Infection
  • Paediatric Lung Disaese
  • Viral infection

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