Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
BMC Pulm Med. 2022 Jun 26;22(1):251. doi: 10.1186/s12890-022-02041-8.
The prognostic value of bronchoalveolar lavage (BAL) fluid analysis in non-human immunodeficiency virus (HIV)-infected patients with Pneumocystis jirovecii pneumonia (PJP) has not been well elucidated. We aimed to investigate the prognostic implication of BAL fluid analysis in non-HIV patients with PJP.
The data of 178 non-HIV patients diagnosed with PJP based on the results of the polymerase chain reaction assay of BAL fluid specimens between April 2018 and December 2020 were retrospectively reviewed. The clinical characteristics, laboratory findings, and BAL fluid analysis results of patients who died within 90 days after hospital admission were compared.
Twenty patients (11.2%) died within 90 days from admission. The neutrophil count in BAL fluid was significantly higher (median 22.0%, interquartile range [IQR] 2.0-46.0% vs. median 6.0%, IQR 2.0-18.0%, P = 0.044), while the lymphocyte count was significantly lower (median 24.0%, IQR 7.0-37.0% vs. median 41.0%, IQR 22.5-60.5%, P = 0.001) in the non-survivor group compared with that in the survivor group. In the multivariate analysis, the C-reactive protein level (odds ratio [OR] 1.093, 95% confidence interval [CI] 1.020-1.170, P = 0.011) and a BAL fluid lymphocyte count of ≤ 30% (OR 3.353, 95% CI 1.101-10.216, P = 0.033) were independently associated with mortality after adjusting for albumin and lactate dehydrogenase levels.
A low lymphocyte count in BAL fluid may be a predictor of mortality in non-HIV patients with PJP.
支气管肺泡灌洗液（BAL）分析在非人类免疫缺陷病毒（HIV）感染的卡氏肺孢子菌肺炎（PJP）患者中的预后价值尚未得到充分阐明。我们旨在研究 BAL 液分析对非 HIV 患者 PJP 的预后意义。
回顾性分析了 2018 年 4 月至 2020 年 12 月期间基于 BAL 液标本聚合酶链反应检测结果诊断为 PJP 的 178 例非 HIV 患者的临床特征、实验室检查和 BAL 液分析结果。比较了入院后 90 天内死亡患者的临床特征、实验室检查和 BAL 液分析结果。
20 例（11.2%）患者在入院后 90 天内死亡。非幸存者组 BAL 液中性粒细胞计数明显较高（中位数 22.0%，四分位距[IQR]2.0-46.0% vs. 中位数 6.0%，IQR 2.0-18.0%，P=0.044），而淋巴细胞计数明显较低（中位数 24.0%，IQR 7.0-37.0% vs. 中位数 41.0%，IQR 22.5-60.5%，P=0.001）。多变量分析显示，C 反应蛋白水平（比值比[OR]1.093，95%置信区间[CI]1.020-1.170，P=0.011）和 BAL 液淋巴细胞计数≤30%（OR 3.353，95%CI 1.101-10.216，P=0.033）是调整白蛋白和乳酸脱氢酶水平后与死亡率相关的独立因素。
BAL 液中淋巴细胞计数低可能是非 HIV 患者 PJP 死亡的预测因素。
