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Diagnostic yield of flexible bronchoscopy for immunocompromised patients with lung infiltrates: A single-center,
Natsuki Nakagawa1, Takahiro Ando1, Masanori Kawakami1
1Department of Respiratory Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Insights
Bronchoscopy aids diagnosis in immunocompromised patients with lung issues. Transbronchial biopsy improves diagnostic yield, proving useful for various underlying conditions, including collagen vascular disease.
Area of Science:
- Pulmonology
- Immunology
- Medical Diagnostics
Background:
- Pulmonary complications significantly increase mortality in immunocompromised patients.
- Bronchoscopy is a recognized tool, but factors influencing its diagnostic yield remain unclear.
- Identifying these factors is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate clinical factors and procedures impacting bronchoscopy's diagnostic yield in immunocompromised patients.
- To assess the safety and efficacy of bronchoscopy in this vulnerable population.
- To determine the utility of bronchoscopy for diagnosing diverse pulmonary conditions.
Main Methods:
- Retrospective analysis of 115 bronchoscopies in 108 immunocompromised patients (corticosteroid/immunosuppressant users).
- Evaluation of clinical data, sampling techniques, diagnoses, and complications.
- Statistical analysis to identify factors influencing diagnostic yield.
Main Results:
- Bronchoscopy yielded a clinical diagnosis in 44% of patients (infectious and non-infectious diseases).
- Transbronchial biopsy significantly improved diagnostic yield (54.7% vs. 35.5%, P=0.049).
- Bronchoscopy proved useful for collagen vascular disease and other disorders; severe complications were rare (0.9%).
Conclusions:
- Transbronchial biopsy is a valuable procedure for diagnosing pulmonary infiltrates in immunocompromised individuals.
- Bronchoscopy is a useful diagnostic tool for immunocompromised patients, including those with collagen vascular disease.
- The study supports the continued use of bronchoscopy for managing complex pulmonary cases in immunocompromised patients.
Background:
Pulmonary complications are associated with mortality in immunocompromised patients. The usefulness of bronchoscopy has been reported. However, clinical factors and procedures that influence diagnostic yield are still not established.
Materials And Methods:
We retrospectively analyzed 115 bronchoscopies performed on 108 immunocompromised patients, defined as those who take corticosteroids and/or immunosuppressants. We evaluated clinical factors, sampling procedures, final diagnosis, and severe complications of bronchoscopy.
Results:
The clinical diagnosis was obtained in 51 patients (44%). Of those, 33 cases were diagnosed as infectious diseases and 18 as non-infectious diseases. Nine out of 115 cases (7.8%) initiated new immunosuppressive treatment for an underlying disorder based on the negative microbiological results obtained with bronchoscopy. Collagen vascular disease was the most common underlying disorders (62 patients, 54%). Bronchoscopy was useful regardless of whether the patient was immunosuppressed to treat collagen vascular disease (P = 0.47). Performing transbronchial biopsy correlated with better diagnostic yield of bronchoscopy (54.7% vs 35.5%, P = 0.049). Other clinical factors, such as radiological findings, respiratory failure or antibiotic use at the time of bronchoscopy did not significantly influence diagnostic yield. Respiratory failure requiring intubation after bronchoscopy occurred only in one case (0.9%).
Conclusions:
Our study implied the transbronchial biopsy may be a useful procedure for reaching a diagnosis in immunocompromised patients with pulmonary infiltrates. In addition, our data suggest the usefulness of bronchoscopy for immunocompromised patients due to the treatment of collagen vascular disease as well as other underlying disorders.
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