Utility of bronchoalveolar lavage in the management of immunocompromised patients presenting with lung infiltrates.
Adenocarcinoma of Lung
/ diagnosis
Adult
Aged
Antineoplastic Agents
/ adverse effects
Bronchoalveolar Lavage
Bronchoalveolar Lavage Fluid
/ cytology
Bronchoscopy
Carcinoma, Squamous Cell
/ diagnosis
Cross-Sectional Studies
Female
HIV Infections
/ immunology
Hematologic Neoplasms
/ immunology
Humans
Hypoxia
/ epidemiology
Immunocompromised Host
Immunosuppressive Agents
/ adverse effects
Leukemia
/ immunology
Lung Neoplasms
/ diagnosis
Lymphoma
/ immunology
Male
Middle Aged
Mortality
Neutropenia
Odds Ratio
Organ Transplantation
Picornaviridae Infections
/ diagnosis
Pneumonia
/ diagnosis
Pneumonia, Pneumocystis
/ diagnosis
Postoperative Complications
/ epidemiology
Postoperative Hemorrhage
/ epidemiology
Pulmonary Eosinophilia
/ diagnosis
Retrospective Studies
Tuberculosis, Pulmonary
/ diagnosis
Bronchoalveolar lavage
Flexible bronchoscopy
Immunocompromised
Lung infiltrates
Journal
BMC pulmonary medicine
ISSN: 1471-2466
Titre abrégé: BMC Pulm Med
Pays: England
ID NLM: 100968563
Informations de publication
Date de publication:
26 Feb 2019
26 Feb 2019
Historique:
received:
09
10
2018
accepted:
04
02
2019
entrez:
28
2
2019
pubmed:
28
2
2019
medline:
14
6
2019
Statut:
epublish
Résumé
Bronchoalveolar lavage (BAL) is utilized for diagnosing lung infiltrates in immunocompromised. There is heterogeneity in the data and reported diagnostic yields range from 26 to 69%. Therefore, selection criteria for BAL to maximize yield and minimize complications are unclear. Objectives of this study were to determine the diagnostic yield and complication rate of BAL in immunocompromised patients presenting with lung infiltrates, and identify factors impacting these outcomes. Exploratory aims included characterization of pathogens, rate of treatment modification and mortality. Retrospective study from January 2012 to December 2016. Patients on mechanical ventilation were excluded. Positive diagnostic yield was defined as confirmed microbiological or cytological diagnosis. A total of 217 patients were recruited (70.1% male and mean age: 51.7 ± 14.6 years). Diagnostic yield was 60.8% and complication rate 14.7%. Complications (hypoxemia and endobronchial bleeding) were all sell-limiting. Treatment modification based on BAL results was 63.3%. In 97.0% an infectious aetiology was identified. HIV infection (OR 5.304, 95% CI 1.611-17.458, p = 0.006) and severe neutropenia (OR 4.253, 95% CI 1.288-14.045, p = 0.018) were associated with positive yield. Leukemia (OR 0.317, 95% CI 0.102-0.982, p = 0.047) was associated with lower yield. No factors impacted complication rate. Overall mortality (90-day) was 17.5% and in those with hematologic malignancy, it was 28.3%. BAL retains utility in diagnosis of immunocompromised patients with lung infiltrates. However, patients with hematologic malignancy have a high mortality and alternative sampling should be considered because of poor results with BAL. ClinicalTrials.gov identifier NCT01374542 . Registered June 16, 2011.
Sections du résumé
BACKGROUND
BACKGROUND
Bronchoalveolar lavage (BAL) is utilized for diagnosing lung infiltrates in immunocompromised. There is heterogeneity in the data and reported diagnostic yields range from 26 to 69%. Therefore, selection criteria for BAL to maximize yield and minimize complications are unclear. Objectives of this study were to determine the diagnostic yield and complication rate of BAL in immunocompromised patients presenting with lung infiltrates, and identify factors impacting these outcomes. Exploratory aims included characterization of pathogens, rate of treatment modification and mortality.
METHODS
METHODS
Retrospective study from January 2012 to December 2016. Patients on mechanical ventilation were excluded. Positive diagnostic yield was defined as confirmed microbiological or cytological diagnosis.
RESULTS
RESULTS
A total of 217 patients were recruited (70.1% male and mean age: 51.7 ± 14.6 years). Diagnostic yield was 60.8% and complication rate 14.7%. Complications (hypoxemia and endobronchial bleeding) were all sell-limiting. Treatment modification based on BAL results was 63.3%. In 97.0% an infectious aetiology was identified. HIV infection (OR 5.304, 95% CI 1.611-17.458, p = 0.006) and severe neutropenia (OR 4.253, 95% CI 1.288-14.045, p = 0.018) were associated with positive yield. Leukemia (OR 0.317, 95% CI 0.102-0.982, p = 0.047) was associated with lower yield. No factors impacted complication rate. Overall mortality (90-day) was 17.5% and in those with hematologic malignancy, it was 28.3%.
CONCLUSION
CONCLUSIONS
BAL retains utility in diagnosis of immunocompromised patients with lung infiltrates. However, patients with hematologic malignancy have a high mortality and alternative sampling should be considered because of poor results with BAL.
TRIAL REGISTRATION
BACKGROUND
ClinicalTrials.gov identifier NCT01374542 . Registered June 16, 2011.
Identifiants
pubmed: 30808314
doi: 10.1186/s12890-019-0801-2
pii: 10.1186/s12890-019-0801-2
pmc: PMC6390608
doi:
Substances chimiques
Antineoplastic Agents
0
Immunosuppressive Agents
0
Banques de données
ClinicalTrials.gov
['NCT01374542']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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