{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T06:30:16Z","timestamp":1780554616046,"version":"3.54.1"},"reference-count":29,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T00:00:00Z","timestamp":1667174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chonnam National University","award":["2020\u20133735"],"award-info":[{"award-number":["2020\u20133735"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Post-infectious bronchiolitis obliterans (PIBO), one of the major complications of respiratory tract infection, is commonly underdiagnosed. To identify the risk groups that may develop PIBO and avoid misdiagnoses, we investigated the risk factors associated with the development of PIBO. We searched PubMed, Embase, and MEDLINE databases for studies that included risk factors for the development of PIBO published from inception to 13 June 2022. We limited our search to studies that reported the estimates of odds ratio (OR), hazard ratio (HR), or relative risks for developing PIBO. A fixed-effect and a random-effect model were used. We included seven studies reporting data on the risk factors for PIBO in 344 children with PIBO and 1310 control children. Twenty-two variables, including sex, age, respiratory pathogens, symptoms, laboratory and radiologic findings, and mechanical ventilation, were mentioned in at least one study. The significant risk factors mentioned in two or more studies included elevated lactate dehydrogenase levels, pleural effusion, hypoxemia, sex, and mechanical ventilation. The significance of the duration of hospitalization and fever as risk factors for PIBO differed when the studies were classified according to the statistical method. In addition, the risk factors differed according to respiratory infection pathogens. This meta-analysis identified potential risk factors associated with the development of PIBO. The results of this study highlight the importance of avoiding misdiagnosis and help establish management strategies for patients at a high risk of developing PIBO.<\/jats:p>","DOI":"10.3390\/pathogens11111268","type":"journal-article","created":{"date-parts":[[2022,11,2]],"date-time":"2022-11-02T06:42:17Z","timestamp":1667371337000},"page":"1268","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Risk Factors for the Development of Post-Infectious Bronchiolitis Obliterans in Children: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0145-7067","authenticated-orcid":false,"given":"Eun","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 61469, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6391-557X","authenticated-orcid":false,"given":"Suyeon","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Applied Statistics, Chung-Ang University, Seoul 06974, Korea"},{"name":"Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul 04401, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyunghoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam 13620, Korea"},{"name":"Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7287-4300","authenticated-orcid":false,"given":"Hyeon-Jong","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,31]]},"reference":[{"key":"ref_1","first-page":"69","article-title":"Post-infectious bronchiolitis obliterans in children","volume":"42","author":"Flanagan","year":"2022","journal-title":"Paediatr. Respir. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1002\/ppul.24221","article-title":"Post-infectious bronchiolitis obliterans","volume":"54","author":"Colom","year":"2019","journal-title":"Pediatr. Pulmonol."},{"key":"ref_3","first-page":"495","article-title":"Bronchiolitis obliterans and pneumonia induced in young dogs by experimental adenovirus infection","volume":"119","author":"Castleman","year":"1985","journal-title":"Am. J. Pathol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"410","DOI":"10.3389\/fmicb.2014.00410","article-title":"Novel aspects on the pathogenesis of Mycoplasma pneumoniae pneumonia and therapeutic implications","volume":"5","author":"Saraya","year":"2014","journal-title":"Front. Microbiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"b2700","DOI":"10.1136\/bmj.b2700","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration","volume":"339","author":"Liberati","year":"2009","journal-title":"BMJ"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"147","author":"Altman","year":"2007","journal-title":"Ann. Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1001\/jamapediatrics.2019.3310","article-title":"Global Prevalence of Hypertension in Children: A Systematic Review and Meta-analysis","volume":"173","author":"Song","year":"2019","journal-title":"JAMA Pediatr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"d4002","DOI":"10.1136\/bmj.d4002","article-title":"Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials","volume":"343","author":"Sterne","year":"2011","journal-title":"BMJ"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"106209","DOI":"10.1016\/j.rmed.2020.106209","article-title":"Risk factors for the development of post-infectious bronchiolitis obliterans after Mycoplasma pneumoniae pneumonia in the era of increasing macrolide resistance","volume":"175","author":"Lee","year":"2020","journal-title":"Respir. Med."},{"key":"ref_10","first-page":"9371406","article-title":"Analysis of Risk Factors of Bronchiolitis Obliterans in Children with Mycoplasma pneumoniae Bronchiolitis","volume":"2022","author":"Huang","year":"2022","journal-title":"Comput. Math. Methods Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1002\/ppul.20984","article-title":"Lower respiratory infections by adenovirus in children. Clinical features and risk factors for bronchiolitis obliterans and mortality","volume":"44","author":"Murtagh","year":"2009","journal-title":"Pediatr. Pulmonol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1186\/s40064-016-3237-7","article-title":"Hypoxemia is an independent predictor of bronchiolitis obliterans following respiratory adenoviral infection in children","volume":"5","author":"Wu","year":"2016","journal-title":"Springerplus"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"722885","DOI":"10.3389\/fped.2021.722885","article-title":"Epidemiology of Adenovirus Pneumonia and Risk Factors for Bronchiolitis Obliterans in Children During an Outbreak in Jilin, China","volume":"9","author":"Yu","year":"2021","journal-title":"Front. Pediatr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3093","DOI":"10.1002\/jmv.25703","article-title":"Risk factors for the development of bronchiolitis obliterans in children with severe adenovirus pneumonia: A retrospective study with dose-response analysis","volume":"92","author":"Zhong","year":"2020","journal-title":"J. Med. Virol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1136\/thx.2005.044909","article-title":"Risk factors for the development of bronchiolitis obliterans in children with bronchiolitis","volume":"61","author":"Colom","year":"2006","journal-title":"Thorax"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4030","DOI":"10.3892\/mmr.2016.5765","article-title":"Insights into the pathogenesis of Mycoplasma pneumoniae","volume":"14","author":"He","year":"2016","journal-title":"Mol. Med. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1097\/BOR.0000000000000494","article-title":"Extra-pulmonary diseases related to Mycoplasma pneumoniae in children: Recent insights into the pathogenesis","volume":"30","author":"Poddighe","year":"2018","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.rinim.2011.11.001","article-title":"Identification of a mechanism for lung inflammation caused by Mycoplasma pneumoniae using a novel mouse model","volume":"1","author":"Saraya","year":"2011","journal-title":"Results Immunol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Han, H.Y., Park, K.C., Yang, E.A., and Lee, K.Y. (2021). Macrolide-Resistant and Macrolide-Sensitive Mycoplasma pneumoniae Pneumonia in Children Treated Using Early Corticosteroids. J. Clin. Med., 10.","DOI":"10.3390\/jcm10061309"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Zhu, Z., Zhang, T., Guo, W., Ling, Y., Tian, J., and Xu, Y. (2021). Clinical characteristics of refractory mycoplasma pneumoniae pneumonia in children treated with glucocorticoid pulse therapy. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-05830-4"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"106053","DOI":"10.1016\/j.phrs.2021.106053","article-title":"Systemic administration of glucocorticoids, cardiovascular complications and mortality in patients hospitalised with COVID-19, SARS, MERS or influenza: A systematic review and meta-analysis of randomised trials","volume":"176","author":"Caiazzo","year":"2022","journal-title":"Pharmacol. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1007\/s12098-022-04205-0","article-title":"Clinical Usefulness of Serum Lactate Dehydrogenase Levels in Mycoplasma pneumoniae Pneumonia in Children","volume":"89","author":"Lee","year":"2022","journal-title":"Indian J. Pediatr."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Kim, S.H., Lee, E., Song, E.S., and Lee, Y.Y. (2021). Clinical Significance of Pleural Effusion in Mycoplasma pneumoniae Pneumonia in Children. Pathogens, 10.","DOI":"10.3390\/pathogens10091075"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e2220949","DOI":"10.1001\/jamanetworkopen.2022.20949","article-title":"Global Trends in the Proportion of Macrolide-Resistant Mycoplasma pneumoniae Infections: A Systematic Review and Meta-analysis","volume":"5","author":"Kim","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1086\/522188","article-title":"Genotype prevalence and risk factors for severe clinical adenovirus infection, United States 2004\u20132006","volume":"45","author":"Gray","year":"2007","journal-title":"Clin. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Crenshaw, B.J., Jones, L.B., Bell, C.R., Kumar, S., and Matthews, Q.L. (2019). Perspective on Adenoviruses: Epidemiology, Pathogenicity, and Gene Therapy. Biomedicines, 7.","DOI":"10.3390\/biomedicines7030061"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1038\/nri2802","article-title":"Immunity and immunopathology to viruses: What decides the outcome?","volume":"10","author":"Rouse","year":"2010","journal-title":"Nat. Rev. Immunol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"881908","DOI":"10.3389\/fped.2022.881908","article-title":"Risk Factors for Post-infectious Bronchiolitis Obliterans in Children: A Systematic Review and Meta-Analysis","volume":"10","author":"Liu","year":"2022","journal-title":"Front. Pediatr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"5852827","DOI":"10.1155\/2020\/5852827","article-title":"Postinfectious Bronchiolitis Obliterans in Children: Diagnostic Workup and Therapeutic Options: A Workshop Report","volume":"2020","author":"Jerkic","year":"2020","journal-title":"Can. Respir. J."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/11\/11\/1268\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:06:28Z","timestamp":1760144788000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/11\/11\/1268"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,31]]},"references-count":29,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["pathogens11111268"],"URL":"https:\/\/doi.org\/10.3390\/pathogens11111268","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,31]]}}}