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Latent Class Analysis to identify clinical profiles among Indigenous infants with bronchiolitis
  • +2
  • Hongqi Niu,
  • Anne Chang,
  • Zhiqiang Wang,
  • Victor Oguoma,
  • Gabrielle McCallum
Hongqi Niu
Menzies School of Health Research
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Anne Chang
Children's Health Queensland Hospital and Health Service
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Zhiqiang Wang
Menzies School of Health Research
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Victor Oguoma
Menzies School of Health Research
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Gabrielle McCallum
Menzies School of Health Research
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Abstract

Abstract Background and Objectives: Better phenotyping of the heterogenous bronchiolitis syndrome may lead to targeted future interventions. This study aims to identify severe bronchiolitis profiles among hospitalised Australian Indigenous infants, a population at high-risk of bronchiectasis, using Latent Class Analysis (LCA). Methods: We included prospectively collected clinical, viral and nasopharyngeal bacteria data from 164 Indigenous infants hospitalised with bronchiolitis. We undertook multiple correspondence analysis (MCA) followed by LCA. The best-fitting model for LCA was based on adjusted Bayesian information criteria and entropy R2. Results: We identified five clinical profiles. Profile-A’s (23.8% of cohort) phenotype was previous preterm (90.7%), low birth-weight (89.2%) and weight-for-length z-score <-1 (82.7% from combining those with z-score between -1 and -2 and those in the z-score of <-2 group) previous respiratory hospitalisation (39.6%) and bronchiectasis on chest high-resolution computed tomography scan (35.4%). Profile-B (25.3%) was characterised by oxygen requirement (100%) and marked accessory muscle use (45.5%). Infants in profile-C (7.0%) had the most severe disease, with oxygen requirement and bronchiectasis in 100%, moderate accessory muscle use (85% vs 0-51.4%) and bacteria detected (93.1% vs 56.7-72.0%). Profile-D (11.6%) was dominated by rhinovirus (49.4%), mild accessory muscle use (73.8%) and weight-for-length z-score <-2 (36.0%). Profile-E (32.2%) included bronchiectasis (13.8%), RSV (44.0%), rhinovirus (26.3%) and any bacteria (72%). Conclusions: Using LCA in Indigenous infants with severe bronchiolitis, we identified 5 clinical profiles with one distinct profile for bronchiectasis. LCA can characterise distinct phenotypes for severe bronchiolitis and infants at risk for future bronchiectasis, which may inform future targeted interventions.

Peer review status:ACCEPTED

20 Jul 2020Submitted to Pediatric Pulmonology
22 Jul 2020Submission Checks Completed
22 Jul 2020Assigned to Editor
26 Jul 2020Reviewer(s) Assigned
06 Aug 2020Review(s) Completed, Editorial Evaluation Pending
12 Aug 20201st Revision Received
13 Aug 2020Submission Checks Completed
13 Aug 2020Assigned to Editor
13 Aug 2020Reviewer(s) Assigned
19 Aug 2020Review(s) Completed, Editorial Evaluation Pending
22 Aug 2020Editorial Decision: Accept