Utility of bronchoalveolar lavage in the management of immunocompromised patients presenting with lung infiltrates

Randall Choo, Naser Salman Hamza Naser, Nivedita Vikas Nadkarni, Devanand Anantham, Randall Choo, Naser Salman Hamza Naser, Nivedita Vikas Nadkarni, Devanand Anantham

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.

Keywords: Bronchoalveolar lavage; Flexible bronchoscopy; Immunocompromised; Lung infiltrates.

Conflict of interest statement

Ethics approval and consent to participate

Data was rendered non-identifiable with removal of patient’s name, identification card number and date of procedure. Waiver of consent was approved by SingHealth Centralised Institutional Review Board. Approval Reference: 2011/350/C.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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