Bronchoalveolar lavage fluid lymphocytosis in chronic hypersensitivity pneumonitis: a systematic review and meta-analysis.
Journal
The European respiratory journal
ISSN: 1399-3003
Titre abrégé: Eur Respir J
Pays: England
ID NLM: 8803460
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
30
01
2020
accepted:
28
03
2020
pubmed:
9
4
2020
medline:
22
6
2021
entrez:
9
4
2020
Statut:
epublish
Résumé
The role of bronchoalveolar lavage fluid (BALF) lymphocyte percentage in diagnosing chronic hypersensitivity pneumonitis (CHP) is unclear. We conducted a systematic review and meta-analysis of bronchoalveolar lavage (BAL) lymphocyte percentage in the diagnosis of CHP. We searched Medline, Embase and the Cochrane Library from inception to August 2019. Individual patient data were obtained to test performance characteristics of BAL lymphocyte percentage at different thresholds. Random-effects models were used for pooled estimates, with comparisons made between CHP and non-CHP interstitial lung diseases (ILDs). Fifty-three studies were included in the systematic review and 42 in the meta-analysis. The pooled estimate for BAL lymphocyte percentage was 42.8% (95% CI 37.7-47.8, I BAL lymphocyte percentage is higher in CHP compared to IPF and other IIPs, with higher thresholds providing improved specificity at the cost of sensitivity. However, the parent studies are at risk of incorporation bias and prospective studies should evaluate the additive discriminate value of BAL lymphocyte percentage to accurately diagnose CHP.
Sections du résumé
BACKGROUND
The role of bronchoalveolar lavage fluid (BALF) lymphocyte percentage in diagnosing chronic hypersensitivity pneumonitis (CHP) is unclear. We conducted a systematic review and meta-analysis of bronchoalveolar lavage (BAL) lymphocyte percentage in the diagnosis of CHP.
METHODS
We searched Medline, Embase and the Cochrane Library from inception to August 2019. Individual patient data were obtained to test performance characteristics of BAL lymphocyte percentage at different thresholds. Random-effects models were used for pooled estimates, with comparisons made between CHP and non-CHP interstitial lung diseases (ILDs).
RESULTS
Fifty-three studies were included in the systematic review and 42 in the meta-analysis. The pooled estimate for BAL lymphocyte percentage was 42.8% (95% CI 37.7-47.8, I
CONCLUSIONS
BAL lymphocyte percentage is higher in CHP compared to IPF and other IIPs, with higher thresholds providing improved specificity at the cost of sensitivity. However, the parent studies are at risk of incorporation bias and prospective studies should evaluate the additive discriminate value of BAL lymphocyte percentage to accurately diagnose CHP.
Identifiants
pubmed: 32265306
pii: 13993003.00206-2020
doi: 10.1183/13993003.00206-2020
pii:
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright ©ERS 2020.
Déclaration de conflit d'intérêts
Conflict of interest: N. Adderley has nothing to disclose. Conflict of interest: C.J. Humphreys has nothing to disclose. Conflict of interest: H. Barnes has nothing to disclose. Conflict of interest: B. Ley has nothing to disclose. Conflict of interest: Z.A. Premji has nothing to disclose. Conflict of interest: K.A. Johannson reports personal fees for advisory board work, consultancy, lectures and travel to meetings from Boehringer Ingelheim, personal fees for advisory board work and lectures from Hoffman La Roche Ltd, personal fees for advisory board work and consultancy from Theravance and Blade Therapeutics, grants from the Chest Foundation, the University of Calgary School of Medicine, the Pulmonary Fibrosis Society of Calgary and UCB Biopharma SPRL, outside the submitted work.