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首页> 外文期刊>BMC Pulmonary Medicine >Utility of bronchoalveolar lavage in the management of immunocompromised patients presenting with lung infiltrates
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Utility of bronchoalveolar lavage in the management of immunocompromised patients presenting with lung infiltrates

机译：支气管肺泡灌洗在免疫功能低下并发肺浸润患者中的应用

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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. 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. 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%. 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. ClinicalTrials.gov identifier NCT01374542 . Registered June 16, 2011.
机译：支气管肺泡灌洗（BAL）用于诊断免疫功能低下的肺浸润。数据存在异质性，报告的诊断产率为26％至69％。因此，尚不清楚BAL使产量最大化和并发症最小化的选择标准。这项研究的目的是确定患有肺浸润的免疫功能低下患者的BAL诊断率和并发症发生率，并确定影响这些结果的因素。探索性目标包括病原体的表征，治疗修改率和死亡率。回顾性研究从2012年1月至2016年12月。机械通气患者被排除在外。诊断阳性率定义为已确诊的微生物学或细胞学诊断。总共招募了217名患者（男性70.1％，平均年龄：51.7±14.6岁）。诊断产率为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）都是限制销售的。基于BAL结果的治疗修改率为63.3％。在97.0％的人群中，发现了感染性病因。 HIV感染（OR 5.304，95％CI 1.611–17.458，p？=？0.006）和严重的中性粒细胞减少症（OR 4.253，95％CI 1.288-14.045，p？=？0.018）与阳性率相关。白血病（OR 0.317，95％CI 0.102-0.982，p？=？0.047）与较低的产量相关。没有因素影响并发症发生率。总体死亡率（90天）为17.5％，血液系统恶性肿瘤为28.3％。 BAL仍可用于诊断免疫功能低下的肺浸润患者。但是，血液系统恶性肿瘤的患者死亡率较高，由于BAL结果差，应考虑选择其他采样方法。 ClinicalTrials.gov标识符NCT01374542。 2011年6月16日注册。

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