Prognostic Value of Bronchoalveolar Lavage in Patients with Non-HIV Pneumocystis Pneumonia

Abstract

Objective Non-HIV patients with pneumocystis pneumonia (PCP) have a poor prognosis. We aimed to evaluate the prognostic factors for in-hospital mortality in terms of the clinical findings, including the results of bronchoalveolar lavage fluid (BALF)-analyses, in non-HIV PCP patients. Methods We retrospectively reviewed non-HIV PCP patients diagnosed using bronchoalveolar lavage between April 2006 and July 2012. For patients with a poor respiratory status, noninvasive positive pressure ventilation (NPPV) was used during the bronchoalveolar lavage (BAL) procedure. Data regarding demographics, laboratory findings and the prognosis were evaluated. Results A total of 29 non-HIV PCP patients were analyzed. NPPV was carried out safely and successfully in 12 patients during the BAL procedure. Twelve patients (41%) died. The multivariate logistic regression analysis identified only BALF neutrophilia to be a significant prognostic factor determining in-hospital mortality. The log-rank test showed that the patients with BALF neutrophilia (! 31%) had a significantly lower survival rate than the other patients (p=0.001). Conclusion Only BALF neutrophilia was found to be a significant predictor of survival in patients with non-HIV PCP. Our data also emphasize the significance of performing BAL in such patients, as it provides both diagnostic and prognostic information.

Risk factors for mortality from pneumocystis carinii pneumonia (PCP) in non-HIV patients: a meta-analysis

“…The diagnosis of PCP was based on the microbiological identification of pneumocystis carinii in suptum, BAL fluid or lung biopsy specimens in 6 studies [ 1 , 9 , 10 , 17 – 19 ]. The diagnosis of PCP in 4 studies (all after 2011) was made on basis of a positive polymerase chain reaction (PCR) result from a sputum or BAL fluid sample or positive microbiological test [ 8 , 13 , 14 , 16 ], and 3 studies only using PCR assay for PCP diagnosis [ 11 , 12 , 15 ] (Table 1 ).…”

Cellular Profiles of Bronchoalveolar Lavage Fluid and Their Prognostic Significance for Non-HIV-Infected Patients with Pneumocystis jirovecii Pneumonia

“…Very limited information is available on the prognostic utility of BAL fluid cellular analysis in non-HIV-infected patients with PCP. A French group and a Japanese group, studying 39 and 29 patients, respectively, found that BAL fluid neutrophilia (Ͼ15% to 30%) might be a significant prognostic factor associated with fatal outcome (10,11). In the current study, we included a relatively large number of cases with enhanced statistical power compared to that of previous studies and provided detailed data on the association between neutrophil incremental increases in BAL fluid and mortality rates according to different cutoff points.…”

“…A few studies have described the cellular profiles of BAL fluid in HIV-infected patients with PCP, and these suggested that BAL fluid neutrophilia might be associated with poor clinical course and outcome (6)(7)(8)(9). Investigations addressing this issue in non-HIV-infected patients with PCP are rare, with small sample sizes (Ͻ40 cases) (10,11). Therefore, we conducted a large cohort study to investigate the prognostic value of BAL fluid cellular analysis in non-HIV-infected patients with PCP.…”

Prognostic impact of pre-existing interstitial lung disease in non-HIV patients withPneumocystispneumonia

“…The 90-day mortality of the patients with increasing KL-6 after the treatment was significantly higher than those with decreasing KL-6 (increasing KL-6, n=19: 78.9%; decreasing KL-6, n=5: 0%). in the absence of pre-existing ILD [30,31]. While the reasons for this discrepancy are unclear, previous studies have reported that the extent of lung damage in neutrophil-impaired knockout mice with PCP were unexpectedly the same as in wild-type mice, and CD8 + T-cell-mediated responses might be more directly responsible for lung injury than neutrophil-mediated inflammation [32,33].…”