INFORMATION ON PROGNOSTIC MARKERS OF SEVERE ACUTE BRONCHITIS IN PRESCHOOLERS: A STUDY IN SUMY REGION IN NORTH-EASTERN UKRAINE
Authors: Havrylenko Anastasiia , Smiyan Oleksandr 
Published: December 2023

Introduction. Respiratory infections, especially in children, are a significant global health concern. Understanding the implications of respiratory infections like acute bronchitis is crucial for devising effective management strategies. These infections, including bronchitis, pneumonia, and influenza, contribute substantially to pediatric hospitalizations. Predicting the severity of acute bronchitis in children is essential for personalized treatment and resource allocation. Developing reliable prognostic tools for acute bronchitis can improve outcomes and optimize healthcare resource utilization.
Methods. The study spanned four years (2018–2021) at "Saint Zinaida's Children's Clinical Hospital" and "Primary Health Care Center No. 2" in Sumy City Council. It involved 135 preschool children with acute bronchitis (study group) and 28 healthy children (control). The control group matched the age and gender of the acute bronchitis group. Inclusion criteria comprised parental consent, ages 3–6, and a diagnosis of acute bronchitis; exclusions included parental refusal, ages below 3 or above 7, concurrent somatic or allergic diseases, non-compliance, and diagnoses other than acute bronchitis. Various methods were employed, including clinical, laboratory, instrumental, and statistical analyses. The severity of acute bronchitis was gauged using the BSS-ped clinical tool. Immunological status assessment involved determining cellular immunity indicators via enzyme-linked immunosorbent assay. Hormonal status analysis included thyroid and cortisol levels via enzyme-linked immunosorbent assay. Statistical analysis utilized SPSS 26 and probabilistic modeling based on Bayes' theorem for building prognostic models and assessing risk factors for acute bronchitis. Fisher's criterion determined reliability at a significance level of 0.05, categorizing risk degrees from low to critically high based on a posteriori chances.
Results. The study successfully identified key clinical, anamnestic, hormonal, and immunological risk factors for severe acute bronchitis in preschoolers, constructing a predictive mathematical model. Breastfeeding and mixed feeding in infants were not associated with increased severity, contrasting with chronic upper respiratory tract disease and parental habits, notably smoking, linked to heightened severity. Cough severity and auscultatory wheezing, with a BSS-ped score of 4, moderately impacted severe acute bronchitis. An outlined prognostic model confirmed hormonal indicators' influence, particularly elevated reverse triiodothyronine levels, on increased risk. Immune cellular activity, specifically CD8+, CD4+, and CD22+, demonstrated pronounced impacts on severe acute bronchitis in preschoolers. A combined aberration of CD3+ and free triiodothyronine, CD3+ and total triiodothyronine, or CD4+ and free triiodothyronine indicated a critically high risk. The model's reliability was affirmed via ROC analysis, displaying a sensitivity of 91.7 %, specificity of 68.2 %, and an AUC of 0.869, indicating its high quality.
Conclusions. In summary, chronic upper respiratory tract disease and parental smoking, particularly when both parents smoke, are significant clinical and anamnestic risk factors for severe acute bronchitis in preschoolers. Cough severity and wheezing on the BSS-ped scale contribute to its development. Hormonal indicators, especially reverse triiodothyronine, display notable impacts, with weaker associations observed for total triiodothyronine and cortisol. Immunological status indicators such as CD22+, CD4+, and CD8+ are also linked to severe acute bronchitis. Combinations of altered CD4+ and free triiodothyronine, CD3+ and free triiodothyronine, CD3+ and total triiodothyronine intensify the risk. When evaluating preschoolers with acute bronchitis, attention to clinical history (chronic upper respiratory disease, parental smoking, severe cough, and pulmonary rales) and specific laboratory parameters (concentration of triiodothyronine, cortisol, and serum levels of CD22+, CD4+, and CD8+) is advisable.