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Utility of bronchoalveolar lavage in the management of immunocompromised patients presenting with lung infiltrates.
BMC Pulm Med. 2019 Feb 26; 19(1):51.BP

Abstract

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

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

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

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

ClinicalTrials.gov identifier NCT01374542 . Registered June 16, 2011.

Links

PMC Free PDF

Authors+Show Affiliations

Choo R
Duke-NUS Medical School, Singapore, Singapore. Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Academia Building Level 3, 20 College Road, S169856, Singapore, Singapore.
Naser NSH
Salmaniya Medical Complex, Manama, Bahrain. Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Academia Building Level 3, 20 College Road, S169856, Singapore, Singapore.
Nadkarni NV
Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore.
Anantham D
Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Academia Building Level 3, 20 College Road, S169856, Singapore, Singapore. anantham.devanand@singhealth.com.sg.

MeSH

Adenocarcinoma of LungAdultAgedAntineoplastic AgentsBronchoalveolar LavageBronchoalveolar Lavage FluidBronchoscopyCarcinoma, Squamous CellCross-Sectional StudiesFemaleHIV InfectionsHematologic NeoplasmsHumansHypoxiaImmunocompromised HostImmunosuppressive AgentsLeukemiaLung NeoplasmsLymphomaMaleMiddle AgedMortalityNeutropeniaOdds RatioOrgan TransplantationPicornaviridae InfectionsPneumoniaPneumonia, PneumocystisPostoperative ComplicationsPostoperative HemorrhagePulmonary EosinophiliaRetrospective StudiesTuberculosis, Pulmonary

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30808314

Clinical Trial Links

Clinical trial which this article describes

Citation

Choo, Randall, et al. "Utility of Bronchoalveolar Lavage in the Management of Immunocompromised Patients Presenting With Lung Infiltrates." BMC Pulmonary Medicine, vol. 19, no. 1, 2019, p. 51.
Choo R, Naser NSH, Nadkarni NV, et al. Utility of bronchoalveolar lavage in the management of immunocompromised patients presenting with lung infiltrates. BMC Pulm Med. 2019;19(1):51.
Choo, R., Naser, N. S. H., Nadkarni, N. V., & Anantham, D. (2019). Utility of bronchoalveolar lavage in the management of immunocompromised patients presenting with lung infiltrates. BMC Pulmonary Medicine, 19(1), 51. https://doi.org/10.1186/s12890-019-0801-2
Choo R, et al. Utility of Bronchoalveolar Lavage in the Management of Immunocompromised Patients Presenting With Lung Infiltrates. BMC Pulm Med. 2019 Feb 26;19(1):51. PubMed PMID: 30808314.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Utility of bronchoalveolar lavage in the management of immunocompromised patients presenting with lung infiltrates. AU - Choo,Randall, AU - Naser,Naser Salman Hamza, AU - Nadkarni,Nivedita Vikas, AU - Anantham,Devanand, Y1 - 2019/02/26/ PY - 2018/10/09/received PY - 2019/02/04/accepted PY - 2019/2/28/entrez PY - 2019/2/28/pubmed PY - 2019/6/14/medline KW - Bronchoalveolar lavage KW - Flexible bronchoscopy KW - Immunocompromised KW - Lung infiltrates SP - 51 EP - 51 JF - BMC pulmonary medicine JO - BMC Pulm Med VL - 19 IS - 1 N2 - 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: 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: 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: 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: ClinicalTrials.gov identifier NCT01374542 . Registered June 16, 2011. SN - 1471-2466 UR - https://www.unboundmedicine.com/medline/citation/30808314/Utility_of_bronchoalveolar_lavage_in_the_management_of_immunocompromised_patients_presenting_with_lung_infiltrates_ DB - PRIME DP - Unbound Medicine ER -