Pulmonary complications in the non-HIV immunocompromised patient

Jepson, S. L.; Pakkal, Mini; Bajaj, Amrita; Raj, Vimal

doi:10.1016/j.crad.2012.02.017

Cited by 8 publications

(7 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Pulmonary infiltrates are a significant cause of morbidity and mortality in immunocompromised patients (1)(2)(3). A mortality rate as high as 77% has been reported along with severe morbidity including 54% requiring admission to the intensive care unit (ICU) and 46% requiring mechanical ventilation (3).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Role of bronchoalveolar lavage in the management of immunocompromised patients with pulmonary infiltrates

Choo¹,

Anantham²

2019

Ann. Transl. Med

View full text Add to dashboard Cite

Pulmonary infiltrates are a significant cause of morbidity and mortality in immunocompromised patients and remain a diagnostic challenge due to the broad range of etiologies that include infection and malignancy. Empiric therapy may be sub-optimal and can adversely impact outcome. Therefore, a confirmed diagnosis is necessary and flexible bronchoscopy with bronchoalveolar lavage (BAL) may be a useful diagnostic tool. Samples are obtained for microbiological and cytological testing, but the procedure carries risk of complications including the adverse events related to moderate sedation. A review of published literature on BAL in immunocompromised patients from the year 2000 was undertaken focusing on diagnostic yield, complication rate, mortality as well as factors impacting these outcomes. Studies in which the majority of patients were supported on mechanical ventilation were excluded. A total of 23 studies (7 prospective and 16 retrospective) met inclusion criteria. This covered 3,395 procedures in 3,192 patients with a mean age of 47.4 years; 60.3% male gender. Diagnostic yield ranged from 26% to 69% with no clear association between diagnostic yield and etiology of immunosuppression or clinical/radiological presentation. Post BAL modification of treatment as an indicator for clinical utility ranged from 11% to 84%; and complication rate ranged from 1% to 52%. No specific factors were associated with increased adverse event rate. This review provides a summary of the data on the use of BAL for diagnosis of pulmonary infiltrates in immunocompromised patients, highlighting the heterogeneity of patients, significant variation in findings reported and the need for more data to optimize patient selection.

show abstract

Section: Introductionmentioning

confidence: 99%

“…A mortality rate as high as 77% has been reported along with severe morbidity including 54% requiring admission to the intensive care unit (ICU) and 46% requiring mechanical ventilation (3). These patients are diagnostic challenges due to their vulnerability to an array of conditions including opportunistic infection and malignancy (1).…”

Section: Introductionmentioning

confidence: 99%

Role of bronchoalveolar lavage in the management of immunocompromised patients with pulmonary infiltrates

Choo¹,

Anantham²

2019

Ann. Transl. Med

View full text Add to dashboard Cite

show abstract

“…3 Noninfectious complications that can contribute to ARI in immunocompromised hosts can include pulmonary edema, drug-induced lung disease, atelectasis, malignancy, radiation-induced lung disease, alveolar hemorrhage, diffuse alveolar damage, organizing pneumonia, rejection of lung transplantation, graft-versus-host disease, and thromboembolic disease (Table 1). 3,30 SUMMARY Chest radiography is indicated early in the evaluation of the immunocompromised patient with ARI. If the radiograph demonstrates a single, focal airspace abnormality and the patient presents with symptoms of an acute bacterial pneumonia, further imaging with CT may not be needed.…”

Section: Variant 4: Positive Chest Radiograph Noninfectious Disease mentioning

confidence: 99%

ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompromised Patients

Heitkamp

Albin

Chung

et al. 2015

Journal of Thoracic Imaging

View full text Add to dashboard Cite

The respiratory system is often affected by complications of immunodeficiency, typically manifesting clinically as acute respiratory illness. Ongoing literature reviews regarding the appropriateness of imaging in these patients are critical, as advanced medical therapies including stem cell transplantation, chemotherapy, and immunosuppressive therapies for autoimmune disease continue to keep the population of immunosuppressed patients in our health care system high. This ACR Appropriateness Criteria topic describes clinical scenarios of acute respiratory illness in immunocompromised patients with cough, dyspnea, chest pain, and fever, in those with negative, equivocal, or nonspecific findings on chest radiography, in those with multiple, diffuse, or confluent opacities on chest radiography, and in those in whom noninfectious disease is suspected. The use of chest radiography, chest computed tomography, transthoracic needle biopsy, and nuclear medicine imaging is discussed in the context of these clinical scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or is not definitive, expert opinion may be used to recommend imaging or treatment.

show abstract

“…Lung infiltrates cause significant morbidity and mortality in immunocompromised patients [1,2]. However, this is a heterogeneous group with various aetiology of underlying immunosuppression.…”

Section: Introductionmentioning

confidence: 99%

Utility of bronchoalveolar lavage in the management of immunocompromised patients presenting with lung infiltrates

et al. 2019

View full text Add to dashboard Cite

Background Bronchoalveolar lavage (BAL) is utilized for diagnosing lung infiltrates in immunocompromised. There is heterogeneity in the data and reported diagnostic yields range from 26 to 69%. Therefore, selection criteria for BAL to maximize yield and minimize complications are unclear. Objectives of this study were to determine the diagnostic yield and complication rate of BAL in immunocompromised patients presenting with lung infiltrates, and identify factors impacting these outcomes. Exploratory aims included characterization of pathogens, rate of treatment modification and mortality. Methods Retrospective study from January 2012 to December 2016. Patients on mechanical ventilation were excluded. Positive diagnostic yield was defined as confirmed microbiological or cytological diagnosis. Results A total of 217 patients were recruited (70.1% male and mean age: 51.7 ± 14.6 years). Diagnostic yield was 60.8% and complication rate 14.7%. Complications (hypoxemia and endobronchial bleeding) were all sell-limiting. Treatment modification based on BAL results was 63.3%. In 97.0% an infectious aetiology was identified. HIV infection (OR 5.304, 95% CI 1.611–17.458, p = 0.006) and severe neutropenia (OR 4.253, 95% CI 1.288–14.045, p = 0.018) were associated with positive yield. Leukemia (OR 0.317, 95% CI 0.102–0.982, p = 0.047) was associated with lower yield. No factors impacted complication rate. Overall mortality (90-day) was 17.5% and in those with hematologic malignancy, it was 28.3%. Conclusion BAL retains utility in diagnosis of immunocompromised patients with lung infiltrates. However, patients with hematologic malignancy have a high mortality and alternative sampling should be considered because of poor results with BAL. Trial registration ClinicalTrials.gov identifier NCT01374542 . Registered June 16, 2011.

show abstract

Pulmonary complications in the non-HIV immunocompromised patient

Cited by 8 publications

References 26 publications

Role of bronchoalveolar lavage in the management of immunocompromised patients with pulmonary infiltrates

Role of bronchoalveolar lavage in the management of immunocompromised patients with pulmonary infiltrates

ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompromised Patients

Utility of bronchoalveolar lavage in the management of immunocompromised patients presenting with lung infiltrates

Contact Info

Product

Resources

About