Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Feb 26;19(1):51.
doi: 10.1186/s12890-019-0801-2.

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

Randall Choo  1   2 , Naser Salman Hamza Naser  3   2 , Nivedita Vikas Nadkarni  4 , Devanand Anantham  5
Affiliations

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

Randall Choo et al. BMC Pulm Med. .

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.

PubMed Disclaimer

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.

References

    1. Rañó A, Agustí C, Benito N, Rovira M, Angrill J, Pumarola T, Torres A. Prognostic factors of non-HIV immunocompromised patients with pulmonary infiltrates. Chest. 2002;122(1):253–261. - PubMed
    1. Jepson SL, Pakkal M, Bajaj A, Raj V. Pulmonary complications in the non-HIV immunocompromised patient. Clin Radiol. 2012;67(10):1001–10. - PubMed
    1. Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, Bousvaros A, Dhanireddy S, Sung L, Keyserling H, Kang I. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014;58(3):e44–100. - PubMed
    1. Rosenow EC, Wilson WR, Cockerill FR. Pulmonary disease in the immunocompromised host (first of two parts) Mayo Clin Proc. 1985;60(7):473–487. - PubMed
    1. Du Rand IA, Blaikley J, Booton R, Chaudhuri N, Gupta V, Khalid S, Mandal S, Martin J, Mills J, Navani N, Rahman NM. British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults. Thorax. 2013;68:i1–i44. - PubMed

MeSH terms

Substances

Associated data