Lipid-laden macrophage index as a marker of aspiration in children, is it reliable? A scoping review

IF 1.2 4区医学 Q3 OTORHINOLARYNGOLOGY

International journal of pediatric otorhinolaryngology Pub Date : 2024-11-01 DOI:10.1016/j.ijporl.2024.112151

Ostap Orishchak , Alexander Moise , Faisal Al-Osamey , Kimberley Kaspy , Sam J. Daniel

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引用次数: 0

Abstract

Introduction

A diagnostic pathway to detect aspiration is challenging and usually requires a multidisciplinary approach and a variety of tests. Lipid-laden macrophage index (LLMI) was first described in 1985 by Corwin and Irwin as a promising tool to detect aspiration. Information in the literature as well as physicians’ opinions about the clinical value of the LLMI remains controversial.

Objectives

To assess the clinical value and possible limitations of LLMI as a diagnostic marker for detecting aspiration in children.

Methods

Based on the available literature we thought to answer the following questions: 1. Is there a reliable cutoff value of LLMI to detect aspiration? 2. What are the limitations of LLMI? We queried 8 electronic databases: Medline, Embase, CINAHL, Cochrane, Global Health, Web of Science, Africa Wide Information, and Global Index Medicus. Studies were selected based on established study criteria. Search was limited to publications in English language including human and animal studies. Authors reviewed 2900 articles and identified 21 relevant to the studied subject.

Results

Research reveals different proposed cutoff values for aspirators ranging from 85 to 200 macrophages. LLMI reliability has several limitations including: inter- and intraobserver variability among pathologists scores, inability to differentiate between exogenous and endogenous lipid content, inconsistencies in the definition of the term “aspiration” in various publications. Also, studies in animal models have shown that the nature of the disease, frequency of aspiration, and the time frame when bronchoalveolar lavage (BAL) is performed, could all contribute to the overlap in LLMI in aspirators versus non-aspirators.

Discussion

Our research demonstrates the limitations of LLMI in distinguishing between aspirators and non-aspirators. We believe based on these findings that airway teams should audit their local data as to the value of BAL in detecting aspiration in their patient population.

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作为儿童吸入标志物的载脂巨噬细胞指数可靠吗？范围综述

导言：检测抽吸的诊断途径具有挑战性，通常需要多学科方法和各种检测。1985年，Corwin和Irwin首次将脂质巨噬细胞指数（LLMI）描述为检测吸入的一种有前途的工具。目的评估 LLMI 作为检测儿童吸入的诊断指标的临床价值和可能存在的局限性。方法根据现有文献，我们试图回答以下问题：1.是否有可靠的 LLMI 临界值来检测吸入？2.LLMI 有哪些局限性？我们查询了 8 个电子数据库：Medline、Embase、CINAHL、Cochrane、Global Health、Web of Science、Africa Wide Information 和 Global Index Medicus。我们根据既定的研究标准对研究进行了筛选。搜索仅限于包括人类和动物研究在内的英文出版物。作者查阅了 2900 篇文章，确定了 21 篇与研究主题相关的文章。研究结果表明，针对吸痰器提出了不同的临界值，从 85 到 200 个巨噬细胞不等。LLMI 的可靠性有几个局限性，包括：病理学家评分的观察者之间和观察者内部的差异性、无法区分外源性和内源性脂质含量、各种出版物对 "抽吸 "一词的定义不一致。此外，对动物模型的研究表明，疾病的性质、吸入的频率以及进行支气管肺泡灌洗（BAL）的时间框架都可能导致吸入者与非吸入者的 LLMI 有所重叠。我们认为，基于这些研究结果，气道团队应该对其本地数据进行审核，以确定 BAL 在检测患者吸入方面的价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International journal of pediatric otorhinolaryngology 医学-耳鼻喉科学

CiteScore

3.20

自引率

6.70%

发文量

276

审稿时长

62 days

期刊介绍： The purpose of the International Journal of Pediatric Otorhinolaryngology is to concentrate and disseminate information concerning prevention, cure and care of otorhinolaryngological disorders in infants and children due to developmental, degenerative, infectious, neoplastic, traumatic, social, psychiatric and economic causes. The Journal provides a medium for clinical and basic contributions in all of the areas of pediatric otorhinolaryngology. This includes medical and surgical otology, bronchoesophagology, laryngology, rhinology, diseases of the head and neck, and disorders of communication, including voice, speech and language disorders.