Usefulness of cellular analysis of bronchoalveolar lavage fluid for predicting the etiology of pneumonia in critically ill patients.

Autor: Choi SH; Department of Infectious diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea., Hong SB; Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea., Hong HL; Department of Infectious diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea., Kim SH; Department of Infectious diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea., Huh JW; Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea., Sung H; Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea., Lee SO; Department of Infectious diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea., Kim MN; Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea., Jeong JY; Department of Infectious diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea., Lim CM; Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea., Kim YS; Department of Infectious diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea., Woo JH; Department of Infectious diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea., Koh Y; Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2014 May 13; Vol. 9 (5), pp. e97346. Date of Electronic Publication: 2014 May 13 (Print Publication: 2014).
DOI: 10.1371/journal.pone.0097346
Abstrakt: Background: The usefulness of bronchoalveolar lavage (BAL) fluid cellular analysis in pneumonia has not been adequately evaluated. This study investigated the ability of cellular analysis of BAL fluid to differentially diagnose bacterial pneumonia from viral pneumonia in adult patients who are admitted to intensive care unit.
Methods: BAL fluid cellular analysis was evaluated in 47 adult patients who underwent bronchoscopic BAL following less than 24 hours of antimicrobial agent exposure. The abilities of BAL fluid total white blood cell (WBC) counts and differential cell counts to differentiate between bacterial and viral pneumonia were evaluated using receiver operating characteristic (ROC) curve analysis.
Results: Bacterial pneumonia (n=24) and viral pneumonia (n=23) were frequently associated with neutrophilic pleocytosis in BAL fluid. BAL fluid median total WBC count (2,815/µL vs. 300/µL, P<0.001) and percentage of neutrophils (80.5% vs. 54.0%, P=0.02) were significantly higher in the bacterial pneumonia group than in the viral pneumonia group. In ROC curve analysis, BAL fluid total WBC count showed the best discrimination, with an area under the curve of 0.855 (95% CI, 0.750-0.960). BAL fluid total WBC count ≥ 510/µL had a sensitivity of 83.3%, specificity of 78.3%, positive likelihood ratio (PLR) of 3.83, and negative likelihood ratio (NLR) of 0.21. When analyzed in combination with serum procalcitonin or C-reactive protein, sensitivity was 95.8%, specificity was 95.7%, PLR was 8.63, and NLR was 0.07. BAL fluid total WBC count ≥ 510/µL was an independent predictor of bacterial pneumonia with an adjusted odds ratio of 13.5 in multiple logistic regression analysis.
Conclusions: Cellular analysis of BAL fluid can aid early differential diagnosis of bacterial pneumonia from viral pneumonia in critically ill patients.
Databáze: MEDLINE
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