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Lawlor CM, Choi SS. Lipid‐Laden Macrophage Index as a Diagnostic Tool for Pediatric Aspiration: A Systematic Review. OTO Open 2023; 7:e33. [PMID: 36998564 PMCID: PMC10046735 DOI: 10.1002/oto2.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/17/2022] [Indexed: 03/30/2023] Open
Abstract
Objective Lipid-laden macrophage index (LLMI) has been proposed as a marker for aspiration on bronchoalveolar lavage. It has also been studied as a marker for gastroesophageal reflux and other pulmonary diseases. This review aims to determine the clinical correlation between LLMI and pediatric aspiration. Data Sources PubMed (MeSH search), Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) portals through December 17th, 2020. Review Methods Preferred Reporting Items for Systematic Review and Meta-Analysis criteria were followed, and a quality assessment of included studies was performed using the Methodological Index for Non-Randomized Studies. Search criteria included all occurrences in the title or abstract of the terms "pulmonary aspiration" and "alveolar macrophages." Results Five studies describing 720 patients met inclusion, 3 retrospective case-control studies, and 2 prospective observational studies. Four studies suggested a link between elevated LLMI and aspiration, and 1 found no association. Control groups varied and included healthy nonaspirators to nonaspirators with other pulmonary diseases. Diagnosis of aspiration was not standardized across the studies. Three papers proposed cutoff values for LLMI, all different. Conclusion The existing literature indicates that LLMI is not a sensitive or specific marker for aspiration. Further study is needed to define the utility of LLMI in pediatric aspiration.
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Affiliation(s)
- Claire M. Lawlor
- Department of OtolaryngologyChildren's National Health SystemWashingtonDistrict of ColumbiaUSA
| | - Sukgi S. Choi
- Department of Otolaryngology and Communication EnhancementBoston Children's HospitalBostonMassachusettsUSA
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Torous VF, Basler D, McEnery C, Astor T, Ly A. Utilization of Oil Red O staining for assessing aspiration risk in lung transplant patients: A multidisciplinary prospective study with clinical practice insights. Cancer Cytopathol 2023; 131:30-36. [PMID: 35946954 DOI: 10.1002/cncy.22636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/18/2022] [Accepted: 06/28/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease with microaspiration has been associated with graft dysfunction in lung transplant patients. Identifying patients with aspiration is clinically important because it enables implementation of appropriate interventions like antireflux therapy. Oil Red O (ORO) staining with determination of the lipid-laden macrophage index (LLMI) has been proposed as a noninvasive surrogate marker in the detection of aspiration. The aim of this study was to prospectively evaluate clinical utilization of ORO staining in the assessment of aspiration risk. METHODS All transbronchial surgical pathology biopsies obtained in lung transplant patients undergoing routine surveillance from August 2020 through November 2021 were included in this study. Clinical team members prospectively ascertained the aspiration risk category (ARC) of each patient both before and after biopsy findings and recorded reasons for change in ARC. RESULTS A total of 132 transbronchial biopsies with concurrent LLMI were included in the study. LLMI was low in 51 cases (38.6%), including 21 of the 54 cases (38.9%) where aspiration was suggested based on the transbronchial biopsy findings. In total, 19 cases (14.4%) underwent a change in ARC post-biopsy including 10 that were upgraded and nine cases that were downgraded. Transbronchial biopsy findings were noted as the reason for change in ARC in the majority (15/19; 79%) of cases; only a minority (2/19; 10.5%) were due to the LLMI. Notably, 16 cases (12.1%) had a low LLMI with high-risk post-biopsy ARC and nine cases (6.8%) had a high LLMI with low-risk post-biopsy ARC. CONCLUSIONS This study observed that clinical evaluation for aspiration relied more heavily on transbronchial biopsy findings. Although LLMI may retain clinical utility in some scenarios, reevaluation of the clinical value of ORO testing would be prudent.
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Affiliation(s)
- Vanda F Torous
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Debra Basler
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Caroline McEnery
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Todd Astor
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Torous VF, Ly A. Correlation between cytology Oil Red O staining and lung biopsy specimens: utility of the lipid-laden macrophage index. J Am Soc Cytopathol 2022; 11:226-233. [PMID: 35597768 DOI: 10.1016/j.jasc.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/07/2022] [Accepted: 04/14/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Oil Red O staining is used for enumeration of the lipid-laden macrophage index (LLMI) as a surrogate for aspiration. As part of quality improvement efforts aimed at optimizing resource utilization, the utility of this stain in current cytopathology practice was re-evaluated. The objective of this study was to explore the clinical utility of Oil Red O staining in bronchoalveolar lavage (BAL) samples by correlating the LLMI with findings in concurrent histologic tissue samples. MATERIALS AND METHODS Lung transbronchial biopsy specimens that suggested aspiration that were submitted with concurrent BAL cytology samples were retrieved. Lung tissue biopsies were reviewed for the presence of foamy alveolar macrophages (graded as 0, 1+, and 2+), foreign material, and giant cells. The concurrent BAL was reviewed with consensus determination of the LLMI. RESULTS A total of 53 cases were identified. On histology, 13 cases (24.5%) were found to have no foamy alveolar macrophages, 23 cases (43.4%) were found to have 1+ foamy alveolar macrophages, and 17 cases (32.1%) were found to have 2+ foamy alveolar macrophages. Six cases (11.3%) were found to have foreign material, and 10 cases (18.9%) were found to have multinucleated giant cells. The average LLMI score was 16, with 44 (83.0%) in the low range (LLMI <40) and 9 (17.0%) in the intermediate range (LLMI of 40-90). CONCLUSIONS None of the cases in our study had an LLMI that exceeded the cutoff value for which aspiration would be suspected. We found no correlation of the LLMI with lung biopsies that suggested aspiration.
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Affiliation(s)
- Vanda F Torous
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Gami A, Rinaldi K, Degefe YT, Vosoughi AS, Lee D, Maleki Z. Bronchoalveolar Lavage in a Pediatric Population. Am J Clin Pathol 2022; 157:678-684. [PMID: 34698346 DOI: 10.1093/ajcp/aqab177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/17/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The cytomorphologic findings of bronchoalveolar lavage (BAL) in pediatrics were correlated with clinical symptoms. METHODS Patient demographics, clinical symptoms/history, cytomorphologic findings, and oil red O (ORO) staining of 100 pediatric patients who underwent BAL between 2014 and 2016 were reviewed at a large academic institution. RESULTS Of the 100 patients (males/females, 62:38), the most common conditions for BAL included cough (46/100), reflux (39/100), pneumonia (30/100), dysphagia (22/100), asthma (19/100), and cystic fibrosis (15/100). Sixteen of 100 patients were admitted with pulmonary symptoms from the emergency department. Cytomorphologic findings showed acute inflammation in 37 BALs and chronic inflammation in 9. Abundant thick mucin was present in 3 cytology cases from patients with cystic fibrosis. Fungal elements were detected in 3 cases (Candida, Aspergillus, and Pneumocystis jirovecii) and viral effects (rhinovirus) in one. Thirty-seven of 100 had rare ORO-positive lipid-laden macrophages (LLMs), 7 of 100 had moderate LLMs, 11 of 100 had numerous LLMs, 18 of 100 had positive staining without the degree of staining, 25 of 100 had negative ORO staining, and 2 of 100 had noncontributory ORO staining. An iron stain was done on 15 BALs (2 positive, 9 negative, and 4 noncontributory). CONCLUSIONS BAL cytology is a useful tool in pediatrics to discriminate underlying causes of aerodigestive system conditions, while ORO staining may occasionally help.
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Affiliation(s)
- Abhishek Gami
- Department of Pathology, The Johns Hopkins University School of Medicine and The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Kristina Rinaldi
- Department of Pathology, The Johns Hopkins University School of Medicine and The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Yordanos T Degefe
- Department of Pathology, The Johns Hopkins University School of Medicine and The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Arghavan Seyed Vosoughi
- Department of Pathology, The Johns Hopkins University School of Medicine and The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Dongwoo Lee
- Department of Pathology, The Johns Hopkins University School of Medicine and The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Zahra Maleki
- Department of Pathology, The Johns Hopkins University School of Medicine and The Johns Hopkins Hospital, Baltimore, MD, USA
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Torous VF, Brackett D, Brown P, Edwin N, Heidarian A, Lobuono C, Sun T, Pitman MB, Ly A. Oil red O staining for lipid-laden macrophage index of bronchoalveolar lavage: interobserver agreement and challenges to interpretation. J Am Soc Cytopathol 2020; 9:563-569. [PMID: 32674937 DOI: 10.1016/j.jasc.2020.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/16/2020] [Accepted: 05/28/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Oil Red O (ORO) staining on cytologic specimens with calculation of the lipid-laden macrophage index (LLMI) is used as a part of the workup in a number of clinical settings, particularly when aspiration is of concern. As a part of ongoing internal quality improvement measures, the objective of the present study was to evaluate the interobserver agreement of the LLMI calculation and to identify factors that affect the variability of the calculation. MATERIALS AND METHODS There were 9 study participants, which included 3 trainees, 3 cytotechnologists, and 3 cytopathologists. Each participant reviewed 100 ORO-stained bronchoalveolar lavage slides and assigned an LLMI score to each case. The scores were categorized into 3 groups according to the associated aspiration risk: low, LLMI <40; intermediate, LLMI 40 to 90; and high, LLMI >90. The participants were also requested to note any challenges to the calculation for each case. RESULTS The interobserver agreement among all participants was fair (κ = 0.23). Stratified by participant group, the interobserver agreement among the trainees was fair (κ = 0.24), among cytotechnologists was fair (κ = 0.32), and among cytopathologists was moderate (κ = 0.60). In 70 cases, at least one participant scored the case at least one category higher than the other participants; in 47 cases there was a two category difference. A primary diagnostic challenge reported by participants was macrophage pigmentation (hemosiderin, anthracosis). CONCLUSIONS We found only fair interobserver agreement among all 9 participants in the study. Hemosiderin and anthracotic pigmentation was a major factor impeding LLMI calculation resulting in overestimation of the LLMI.
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Affiliation(s)
- Vanda F Torous
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Diane Brackett
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Peter Brown
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nisha Edwin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Amin Heidarian
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Cinzia Lobuono
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tong Sun
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Martha B Pitman
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Sergi CM. Lower Respiratory Tract. PATHOLOGY OF CHILDHOOD AND ADOLESCENCE 2020:139-253. [DOI: 10.1007/978-3-662-59169-7_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Faro A, Wood RE, Schechter MS, Leong AB, Wittkugel E, Abode K, Chmiel JF, Daines C, Davis S, Eber E, Huddleston C, Kilbaugh T, Kurland G, Midulla F, Molter D, Montgomery GS, Retsch-Bogart G, Rutter MJ, Visner G, Walczak SA, Ferkol TW, Michelson PH. Official American Thoracic Society Technical Standards: Flexible Airway Endoscopy in Children. Am J Respir Crit Care Med 2015; 191:1066-80. [DOI: 10.1164/rccm.201503-0474st] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Carden MA, Barman A, Massey G. Pulmonary alveolar proteinosis in association with congenital dyserythropoietic anemia: a case report. Case Rep Pediatr 2012; 2012:624740. [PMID: 22953144 PMCID: PMC3395170 DOI: 10.1155/2012/624740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 04/12/2012] [Indexed: 12/03/2022] Open
Abstract
A two-year-old girl with congenital dyserythropoietic anemia (CDA) acutely developed fever, tachypnea, and increased oxygen requirement. Chest X-ray revealed bilateral interstitial infiltrates and mild cardiomegaly. Blood cultures grew no infectious agents, while pulmonary specimens grew cytomegalovirus (CMV). Treatment with intravenous ganciclovir was initiated but without response. Final cytologic preparations of bronchoalveolar lavage (BAL) fluid revealed eosinophilic amorphous material consistent with pulmonary alveolar proteinosis (PAP). CDA and PAP are extremely rare disorders in pediatrics. PAP should be considered in patients with hematological disorders who present with acute interstitial pneumonia, after infectious causes are ruled out.
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Affiliation(s)
- Marcus A. Carden
- Departments of Internal Medicine and Pediatrics, Virginia Commonwealth University, 1001 East Marshall Street, Richmond, VA 23298-0646, USA
| | - Ashish Barman
- Division of Anatomic Pathology, Department of Pathology, Virginia Commonwealth University, Richmond, VA 23298-0646, USA
| | - Gita Massey
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA 23298-0646, USA
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Colombo JL, Hallberg TK. Aspiration: a common event and a clinical challenge. Pediatr Pulmonol 2012; 47:317-20. [PMID: 22006650 DOI: 10.1002/ppul.21560] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 08/28/2011] [Indexed: 11/08/2022]
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Rosen R, Johnston N, Hart K, Khatwa U, Nurko S. The presence of pepsin in the lung and its relationship to pathologic gastro-esophageal reflux. Neurogastroenterol Motil 2012; 24:129-33, e84-5. [PMID: 22141343 PMCID: PMC3307906 DOI: 10.1111/j.1365-2982.2011.01826.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
BACKGROUND Pepsin has been proposed as a biomarker of reflux-related lung disease. The goal of this study was to determine (i) if there is a higher reflux burden as measured by pH-MII in patients that are pepsin positive in the lung, and (ii) the sensitivity of pepsin in predicting pathologic reflux by pH, MII, and EGD. METHODS We recruited children between the ages of 1-21 with chronic cough or asthma undergoing bronchoscopy, esophagogastroduodenoscopy (EGD), and multichannel intraluminal impedance (pH-MII) probe placement. The reflux profiles were compared between those patients who were pepsin positive and negative; proportions were compared using Chi-squared analyses and means were compared using t-testing. KEY RESULTS Only the mean number of non-acid reflux events was associated with pepsin positivity (0.04). The sensitivity and specificity of pepsin in predicting pathologic reflux by pH-MII or EGD was 57% and 65%, respectively. The positive predictive value of pepsin in predicting pathologic reflux by pH, MII or EGD was 50% (11/22), and the negative predictive value was 71% (20/28). There was a significantly higher mean LLMI in patients who were pepsin positive compared with pepsin negative patients (81 ± 54 vs 47 ± 26, P = 0.001). CONCLUSIONS & INFERENCES Lung pepsin cannot predict pathologic reflux in the esophagus, but its correlation with lung inflammation suggests that pepsin may be an important biomarker for reflux-related lung disease.
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Affiliation(s)
- Rachel Rosen
- Center for Motility and Functional Gastrointestinal Disorders, Children’s Hospital Boston, Boston, MA
| | - Nikki Johnston
- Department of Otolaryngology and Communication Services, Medical College of Wisconsin, Milwaukee, WI
| | - Kristen Hart
- Center for Motility and Functional Gastrointestinal Disorders, Children’s Hospital Boston, Boston, MA
| | - Umakanth Khatwa
- Division of Pulmonary Medicine, Children’s Hospital Boston, Boston, MA
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Children’s Hospital Boston, Boston, MA
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Trinick R, Johnston N, Dalzell AM, McNamara PS. Reflux aspiration in children with neurodisability--a significant problem, but can we measure it? J Pediatr Surg 2012; 47:291-8. [PMID: 22325378 DOI: 10.1016/j.jpedsurg.2011.11.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 11/10/2011] [Indexed: 02/07/2023]
Abstract
Recurrent respiratory problems are common in children with severe neurodisability, and respiratory deterioration is a leading cause of premature death in this group. Although the etiology is multifactorial, recurrent pulmonary aspiration is thought to play a significant role. Gastroesophageal reflux is known to be common, as is oral-motor discoordination. Differentiating direct aspiration of food and saliva and gastric reflux aspiration is difficult and presents a challenge in managing patients and assessing their suitability for surgical antireflux procedures. This is particularly the case when children present with predominantly respiratory symptoms, where there may be direct aspiration, reflux aspiration, neither, or both. A clinical biomarker to identify and quantify reflux aspiration would therefore be useful in surgical assessment and may also be applicable as an outcome measure for clinical trials of antireflux surgery. In this review, we discuss the evidence base behind existing and potentially novel biomarkers of aspiration in bronchoalveolar lavage fluid. We highlight the limitations of the lipid-laden macrophage index, particularly with regard to its specificity and interrater/intrarater reliability. We discuss the laboratory methods available to measure promising new biomarkers (pepsin and bile acids) and highlight their potential advantages and disadvantages. Finally, to understand how aspiration causes clinical signs and symptoms in our patients, we need to study the effect of aspirated substances on the lung, and here we review the available in vivo and in vitro literature.
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Affiliation(s)
- Ruth Trinick
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Reid-Nicholson M, Kulkarni R, Adeagbo B, Looney S, Crosby J. Interobserver and intraobserver variability in the calculation of the lipid-laden macrophage index: Implications for its use in the evaluation of aspiration in children. Diagn Cytopathol 2010; 38:861-5. [DOI: 10.1002/dc.21298] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Jaoude PA, Knight PR, Ohtake P, El-Solh AA. Biomarkers in the diagnosis of aspiration syndromes. Expert Rev Mol Diagn 2010; 10:309-19. [PMID: 20370588 PMCID: PMC2882092 DOI: 10.1586/erm.10.7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Recognizing and managing the different types of aspiration events remain a challenging task due to the lack of distinguishing clinical or laboratory characteristics. Numerous biomarkers in serum, sputum and bronchoalveolar lavage have been studied, and their role in the recognition of aspiration remains controversial at this time. Recent animal investigations using an array of biomarkers based on distinct pathogenic features of each aspiration event have produced promising results; however, they have not been validated in humans. Newer markers are being introduced as diagnostic and prognostic tools in conditions such as community-acquired pneumonia and sepsis, but they have not been examined in aspiration. The present review summarizes the different biomarkers that have been studied in aspiration and those who might have a potential clinical use in the future.
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Affiliation(s)
- Philippe Abou Jaoude
- The Veterans Affairs Western New York, Healthcare System, Buffalo, NY, USA and Western New York Respiratory Research Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, NY, USA
| | - Paul R Knight
- The Veterans Affairs Western New York, Healthcare System, Buffalo, NY, USA and Department of Anesthesiology, State University of New York at Buffalo School of Medicine and Biomedical Sciences and School of Public Health and Health Professions, NY, USA
| | - Patricia Ohtake
- Department of Rehabilitation Science, State University of New York at Buffalo School of Medicine and Biomedical Sciences and School of Public Health and Health Professions, NY, USA
| | - Ali A El-Solh
- Medical Research, Bldg 20 (151) VISN02, VA Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215-1199, USA and Western New York Respiratory Research Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, NY, USA and Department of Social and Preventive Medicine State University of New York at Buffalo School of Medicine and Biomedical Sciences and School of Public Health and Health Professions, NY, USA, Tel.: +1 716 862 7366, Fax: +1 425 675 4502
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Rosen R, Fritz J, Nurko A, Simon D, Nurko S. Lipid-laden macrophage index is not an indicator of gastroesophageal reflux-related respiratory disease in children. Pediatrics 2008; 121:e879-84. [PMID: 18362101 PMCID: PMC3293162 DOI: 10.1542/peds.2007-0723] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The lipid-laden macrophage index has been used to evaluate for gastroesophageal reflux-related respiratory disease, but the relationship between reflux detected by pH probe and the lipid-laden macrophage index is uncertain despite widespread use of the lipid-laden macrophage index in clinical decision-making. It was the aim of this study to correlate reflux as detected by multichannel intraluminal impedance with the lipid-laden macrophage index. METHODS Patients undergoing both pH multichannel intraluminal impedance testing and bronchoscopy between January 2002 and January 2006 were identified. Baseline characteristics were compared by using parametric and nonparametric testing. Reflux profiles were correlated with the lipid-laden macrophage index by using Spearman correlations. RESULTS There was no significant correlation between the lipid-laden macrophage index and the number of acid or nonacid reflux events. There also was no significant correlation between the lipid-laden macrophage index and the amount of full-column reflux. There was no significant difference between the mean lipid-laden macrophage index in patients with and without esophagitis. Finally, in patients who underwent fundoplication (n = 13) for intractable respiratory disease, there was no significant difference in any of the reflux parameters between patients who did and did not experience clinical improvement after fundoplication. There was, however, a higher lipid-laden macrophage index in patients with no symptomatic improvement compared with patients with symptomatic improvement. CONCLUSIONS Lipid-laden macrophage index lacks the specificity necessary to detect reflux-related respiratory disease.
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Affiliation(s)
- Rachel Rosen
- Center for Aerodigestive Disorders, Department of Pediatric Gastroenterology and Nutrition, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA.
| | - Julia Fritz
- Center for Aerodigestive Disorders, Department of Pediatric Gastroenterology and Nutrition, Children's Hospital Boston, Boston, Massachusetts
| | - Ariela Nurko
- Center for Aerodigestive Disorders, Department of Pediatric Gastroenterology and Nutrition, Children's Hospital Boston, Boston, Massachusetts
| | - Dawn Simon
- Department of Pediatric Pulmonary Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Samuel Nurko
- Center for Aerodigestive Disorders, Department of Pediatric Gastroenterology and Nutrition, Children's Hospital Boston, Boston, Massachusetts
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Furuya MEY, Moreno-Córdova V, Ramírez-Figueroa JL, Vargas MH, Ramón-García G, Ramírez-San Juan DH. Cutoff value of lipid-laden alveolar macrophages for diagnosing aspiration in infants and children. Pediatr Pulmonol 2007; 42:452-7. [PMID: 17427898 DOI: 10.1002/ppul.20593] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Chronic passage of gastric and/or alimentary material into the airways is a frequent and difficult-to-diagnose condition. Because alveolar macrophages phagocytose aspirated material, it has been suggested that their identification is a useful diagnostic method. To know the usefulness of the lipid-laden alveolar macrophages (LLAM) index as a diagnostic tool for aspiration, children from 1 month to 16 years of age were included in three groups: G-I, children with pulmonary pathology and suspicion of aspiration by clinic or image evaluation; G-II, with pulmonary pathology without suspicion of aspiration; and G-III, without respiratory symptoms nor suspicion of aspiration. Bronchoalveolar lavage was obtained through bronchoscopy in G-I and G-II, and through endotracheal tube in G-III, and the LLAM index (0-400) was determined. A total of 112 patients (41, 30, and 41 in G-I to III, respectively) were studied. LLAM index (mean +/- SEM) was highest in G-I (233.2 +/- 5.5), as compared with G-II (187.8 +/- 11.6, P < 0.05), and G-III (108.5 +/- 13.5, P < 0.001). However, notable overlap of LLAM values was observed between G-I and G-II, and between G-II and G-III. When patients from G-I and G-III were jointly analyzed, the area under the ROC curve for diagnosing aspiration was 0.92, with a best cutoff value of >165 (98.6% sensitivity, 78.0% specificity, 87.8% overall accuracy). LLAM index, with a cutoff value of >165 is a useful diagnostic test for aspiration when there is suspicion of this condition. However, due to its low specificity, it does not discriminate other causes of chronic lung disease.
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Affiliation(s)
- María E Y Furuya
- Unidad de Investigación Médica en Enfermedades Respiratorias, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
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