[Effects of diagnostic protocols on etiology and outcome in immunocompromised host with pulmonary infiltrate]

To explore the effects of diagnostic protocols on etiology and outcome in immunocompromised host (ICH) with pulmonary infiltrate.

For this historic control study, ICH with acute respiratory failure (ARF) were eligible as study group (n = 65) in 2009 while another ICH cohort was selected as control group (n = 45) in 2007. The protocol consisted of four parts: judgment possible site, determining probable etiology, checking and feedbacks on laboratory test in 12 hours and reassessment and adjustment treatment in 48-72 hours. The etiologies included infection, non-infection and unknown causes.

Their average age was 45.3 years (range: 22 - 71). Causes of immune suppression were autoimmune disease (n = 69), hematological disorders (n = 21), solid cancers (n = 10) and others (n = 10). When two groups were compared, basic diseases, organ function and disease severity showed no significant difference, but etiologic diagnoses rate (73.8% vs 57.8%), time from ICU admission to diagnosis (4.0 vs 6.8 days) and 28-day mortality (38.5% vs 62.2%) had significant difference (P < 0.05).

Implementation of clinical protocol in ICH with ARF is associated with improved etiologic diagnoses and decreased mortality.