支气管肺泡灌洗在免疫功能低下患者肺部浸润性病变中的应用。
Utility of bronchoalveolar lavage in the management of immunocompromised patients presenting with lung infiltrates.
机构信息
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.
出版信息
BMC Pulm Med. 2019 Feb 26;19(1):51. doi: 10.1186/s12890-019-0801-2.
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.
背景
支气管肺泡灌洗（BAL）用于诊断免疫功能低下患者的肺部浸润。数据存在异质性，报告的诊断率为 26%至 69%。因此，BAL 以最大程度提高产量并最小化并发症的选择标准尚不清楚。本研究的目的是确定免疫功能低下患者肺部浸润行 BAL 的诊断率和并发症发生率，并确定影响这些结果的因素。探索性目的包括病原体特征、治疗方法改变率和死亡率。
方法
回顾性研究，时间为 2012 年 1 月至 2016 年 12 月。排除机械通气患者。阳性诊断率定义为确认的微生物学或细胞学诊断。
结果
共招募 217 例患者（70.1%为男性，平均年龄：51.7±14.6 岁）。诊断率为 60.8%，并发症发生率为 14.7%。并发症（低氧血症和支气管内出血）均为自限性。根据 BAL 结果进行的治疗方法改变率为 63.3%。97.0%的患者确定了感染病因。HIV 感染（OR 5.304，95%CI 1.611-17.458，p=0.006）和严重中性粒细胞减少症（OR 4.253，95%CI 1.288-14.045，p=0.018）与阳性产量相关。白血病（OR 0.317，95%CI 0.102-0.982，p=0.047）与产量较低相关。无因素影响并发症发生率。总体 90 天死亡率为 17.5%，血液恶性肿瘤患者死亡率为 28.3%。
结论
BAL 对诊断肺部浸润的免疫功能低下患者仍然有效。然而，血液恶性肿瘤患者死亡率较高，由于 BAL 结果不佳，应考虑其他取样方法。
试验注册
ClinicalTrials.gov 标识符 NCT01374542。注册于 2011 年 6 月 16 日。
Zotero 插件