Fever after bronchoscopy: serum procalcitonin enables early diagnosis of post-interventional bacterial infection

Abstract

BackgroundThe aim of this study was to differentiate unspecific and self-limiting fever after bronchoscopy from fever due to infection by using serum procalcitonin, C-reactive protein and neutrophil count. Furthermore, frequency of fever after bronchoscopy and procedures as possible risk factors were evaluated.MethodsThree hundred and fourteen consecutive patients were included. All bronchoscopies were performed using jet-ventilation and general anesthesia. Patients were analyzed according to interventions performed during bronchoscopy and laboratory results. Microbiological assessment was done in patients who developed fever to prove or rule out a bacterial infection.ResultsForty-four patients showed fever within 24 h following bronchoscopy (14%). A bacterial infection was proven in 11 patients with fever (3.5%). Procalcitonin, neutrophil count and C-reactive protein were significantly higher in patients with fever after bronchoscopy compared to non-fever patients. To predict bacterial infection in the receiver operating analysis, procalcitonin had the highest area under the curve (0.942; 95% confidence interval [CI], 0.768 to 1.000; p = <0.001), followed by neutrophil count (AUC, 0.804; 95% CI, 0.606 to 0.946; p = 0.005), whereas CRP levels where not statistically significant. Endoscopic airway recanalization was the only intervention that induced fever more frequently than all other interventions (OR 13.629).ConclusionsFever is frequently seen after bronchoscopy and in some cases caused by bacterial infection. Procalcitonin might be useful to distinguish a bacterial infection from unspecific self-limiting fever. Airway recanalization is a procedure that seems to induce fever significantly more often than other bronchoscopic interventions.

Comparison of paired human nasal and bronchial airway epithelial cell responses to rhinovirus infection and IL‐13 treatment

“…A bronchoscopy is an adequate technique for physicians and scientists to obtain airway cells (e.g., bronchial brushings) or tissues from a patient’s lower airway to diagnose diseases and perform basic and translational research. However, there are risks following a bronchoscopy including bronchial spasms, bleeding and infection [ 1 ]. A minimally invasive approach such as nasal brushings is urgently needed to study lower airway diseases such as asthma.…”

Post-Endoscopy Self-Limited Unspecified Fever. Rare or Common Adverse Event after Endoscopy? An Observational, Cross-Sectional Study

“…Fever after bronchoscopy, especially bronchoalveolar lavage (BAL) suggested by several authors may initiate by an endogenous immune response. A systemic in ammatory response is characterized by an increase in circulating cytokine levels such as tumor necrosis factor (TNF)-alpha, interleukin (IL)-1 beta, and IL-6 [9][10][11][12]. During polypectomy, adenomatous polyps have an in ammatory stromal microenvironment, rich in macrophages, neutrophils, and T helper cells [13] that can be a trigger for endogenous immune response.…”

Construction of a Risk Prediction Model for Fever After Painless Bronchoscopy

“…Fever is a common complication after bronchoscopy, and the related literature reports that the incidence is about 10–20% [ 4 – 6 ]. Further studies showed that fever incidence rates after bronchoscopy in elderly people over 80 years old and those under 80 years old were 7.6% and 4.1%, respectively, and there was no statistically significant difference between them [ 7 ].…”