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
. 2021 Jul;13(7):4146-4155.
doi: 10.21037/jtd-20-2596.

Fractional analysis of bronchoalveolar lavage in systemic sclerosis-associated interstitial lung disease

Kazumasa Kase  1   2 , Satoshi Watanabe  1 , Keigo Saeki  1 , Yuko Waseda  3 , Hazuki Takato  2 , Yukari Ichikawa  4 , Akari Murata  5 , Masahide Yasui  6 , Ohkura Noriyuki  1 , Johsuke Hara  1 , Takashi Sone  1 , Miki Abo  1 , Hideharu Kimura  1 , Kazuo Kasahara  1
Affiliations

Fractional analysis of bronchoalveolar lavage in systemic sclerosis-associated interstitial lung disease

Kazumasa Kase et al. J Thorac Dis. 2021 Jul.

Abstract

Background: The utility of bronchoalveolar lavage (BAL) in the evaluation of systemic sclerosis-associated interstitial lung disease (SSc-ILD) remains controversial. Fractional analysis of BAL (FBAL) is a technique that can analyze small airways and alveolar compartments separately and has proven informative in other ILDs. The aim of this study was to explore FBAL characteristics across the spectrum of SSc-ILD severity.

Methods: We retrospectively reviewed patients with SSc-ILD who underwent bronchoscopy with FBAL using three 50 mL aliquots of saline solution. These aliquots were analyzed separately for differential cell composition (FBAL-1, -2, and -3). We compared the FBAL cell composition to the progression of ILD and end-stages of ILD using Cox proportional hazards models.

Results: Sixty-eight patients with SSc-ILD were enrolled in this study. The percentage of neutrophils and eosinophils was lower in FBAL-3 compared to FBAL-1. In contrast, the percentage of macrophages and lymphocytes was higher in FBAL-3. Neutrophils in FBAL-2, -3, and the estimated total FBAL cell fraction (FBAL-total) were negatively correlated with the forced vital capacity % predicted (r=-0.420, -0.362, -0.409, respectively). Although FBAL-total was not linked to the progression and end-stage of ILD, a high percentage of neutrophils in FBAL-3 was significantly associated with the development of end-stage ILD (HR 1.093, 95% CI: 1.003-1.190).

Conclusions: A higher percentage of neutrophils in FBAL-3 is correlated with development of end-stage ILD in SSc-ILD as well as mortality.

Keywords: Fractional bronchoalveolar lavage; interstitial lung disease (ILD); scleroderma; systemic sclerosis (SSc).

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/jtd-20-2596). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Comparison of progression free survival according to neutrophil levels in FBAL-3. FBAL, fractional bronchoalveolar lavage.
See this image and copyright information in PMC

References

    1. Denton CP, Khanna D. Systemic sclerosis. Lancet 2017;390:1685-99. 10.1016/S0140-6736(17)30933-9 - DOI - PubMed
    1. Al-Dhaher FF, Pope JE, Ouimet JM. Determinants of morbidity and mortality of systemic sclerosis in Canada. Semin Arthritis Rheum 2010;39:269-77. 10.1016/j.semarthrit.2008.06.002 - DOI - PubMed
    1. Nihtyanova SI, Schreiber BE, Ong VH, et al. Prediction of pulmonary complications and long-term survival in systemic sclerosis. Arthritis Rheumatol 2014;66:1625-35. 10.1002/art.38390 - DOI - PubMed
    1. Hoffmann-Vold AM, Aalokken TM, Lund MB, et al. Predictive value of serial high-resolution computed tomography analyses and concurrent lung function tests in systemic sclerosis. Arthritis Rheumatol 2015;67:2205-12. 10.1002/art.39166 - DOI - PubMed
    1. Goh NS, Hoyles RK, Denton CP, et al. Short-Term Pulmonary Function Trends Are Predictive of Mortality in Interstitial Lung Disease Associated With Systemic Sclerosis. Arthritis Rheumatol 2017;69:1670-8. 10.1002/art.40130 - DOI - PubMed