Diagnostic Yield of Bronchoscopy in Obtaining Microorganisms in Patients with Rheumatic Autoimmune Disease and Pulmonary Abnormality: Influencing Factors Analysis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

SunXuefeng , LiuYongjian , XiaoYi ,  XuWenbing

Department of Pulmonary Medicine, Peking Union Medical College Hospital, Beijing, 100730, China;

Corresponding author：

XuWenbing, Email: xuwenbing60@163.com

Keywords：

Bronchoscopy; Microorganisms; Pulmonary abnormality; Rheumatic autoimmune disease

DOI：

10.7507/1671-6205.2014067

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Objective Pulmonary infection is commonly seen in patients with rheumatic autoimmune disease (RAD).Sometimes bronchoscopy is used to obtain microorganisms.In order to improve diagnostic yield, the factors affecting diagnostic yield of bronchoscopy in obtaining microorganisms in RAD patients with pulmonary abnormality were analyzed retrospectively. Methods A retrospective study was performed in RAD patients with lung infiltrates who received bronchoscopy for obtaining microorganisms at the Department of Rheumatology,Peking Union Medical College Hospital from January 2009 to June 2013.Patients characteristics,clinical symptoms,medication history,laboratory parameters,radiographic findings and locations where microorganisms were obtained were recorded. Results 87 patients received 91 bronchoscopic exams,including 72 bronchoalveolar lavages,21 bronchial aspirates,and 72 bronchial brushes.The total diagnostic yield was 52.7%.The diagnostic yield was 71.4% with bronchoalveolar lavage,38.9% with bronchial aspirate,and 18.1% with bronchial brush.Diagnostic yield was significantly higher in the patients with clinical symptoms of fever,cough or expectoration compared with the patients without either symptoms (60.0%% vs.34.6%,P=0.028).The patients with CT finding of nodular,massive or consolidation had a higher diagnostic yield compared with those with CT findings of reticular,linear or ground glass opacity (61.8% vs.26.1%,P=0.003).Diagnostic yield was not affected by location of bronchoalveolar lavage (P=0.691). Conclusion RAD patients with fever,cough or sputum,and CT findings of nodular,massive or consolidation would get a higher diagnostic yield by bronchoscopy.

Citation： SunXuefeng, LiuYongjian, XiaoYi, XuWenbing. Diagnostic Yield of Bronchoscopy in Obtaining Microorganisms in Patients with Rheumatic Autoimmune Disease and Pulmonary Abnormality: Influencing Factors Analysis. Chinese Journal of Respiratory and Critical Care Medicine, 2014, 13(3): 277-280. doi: 10.7507/1671-6205.2014067 Copy

1.	Martin WJ 2nd,Smith TF,Sanderson DR,et al.Role of bronchoalveolar lavage in the assessment of opportunistic pulmonary infections:utility and complications.Mayo Clinic Proc,1987,62:549-557.
2.	White P,Bonacum JT,Miller CB.Utility of fiberoptic bronchoscopy in bone marrow transplant patients.Bone Marrow Transplant,1997,20:681-687.
3.	Patel NR,Lee PS,Kim JH,et al.The influence of diagnostic bronchoscopy on clinical outcomes comparing adult autologous and allogeneic bone marrow transplant patients.Chest,2005,127:1388-1396.
4.	Stover DE,Zaman MB,Hajdu SI,et al.Bronchoalveolar lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host.Ann Intern Med,1984,101:1-7.
5.	Feinstein MB,Mokhtari M,Ferreiro R,et al.Fiberoptic bronchoscopy in allogeneic bone marrow transplantation:findings in the era of serum cytomegalovirus antigen surveillance.Chest,2001,120:1094-1100.
6.	Hummel M,Rudert S,Hof H,et al.Diagnostic yield of bronchoscopy with bronchoalveolar lavage in febrile patients with hematologic malignancies and pulmonary infiltrates.Ann Hematol,2008,87:291-297.
7.	Rano A,Agusti C,Jimenez P,et al.Pulmonary infiltrates in non-HIV immunocompromised patients:a diagnostic approach using non-invasive and bronchoscopic procedures.Thorax,2001,56:379-387.
8.	Eriksson BM,Dahl H,Wang FZ,et al.Diagnosis of pulmonary infections in immunocompromised patients by fiber-optic bronchoscopy with bronchoalveolar lavage and serology.Scand J Infect Dis,1996,28:479-485.
9.	Dunagan DP,Baker AM,Hurd DD,et al.Bronchoscopic evaluation of pulmonary infiltrates following bone marrow transplantation.Chest,1997,111:135-141.
10.	Huaringa AJ,Leyva FJ,Signes-Costa J,et al.Bronchoalveolar lavage in the diagnosis of pulmonary complications of bone marrow transplant patients.Bone Marrow Transplant,2000,25:975-979.
11.	Velez L,Correa LT,Maya MA,et al.Diagnostic accuracy of bronchoalveolar lavage samples in immunosuppressed patients with suspected pneumonia:analysis of a protocol.Respir Med,2007,101:2160-2167.
12.	Jain P,Sandur S,Meli Y,et al.Role of flexible bronchoscopy in immunocompromised patients with lung infiltrates.Chest,2004,125:712-722.
13.	Brownback KR,Simpson SQ.Association of bronchoalveolar lavage yield with chest computed tomography findings and symptoms in immunocompromised patients.Ann Thorac Med,2013,8:153-159.
14.	Gleckman RA,Czachor JS.Antibiotic side effects.Seminars Respir Critical Care Med,2000,21:53-60.
15.	Brownback K,Simpson S.Factors affecting diagnostic yield of bronchoalveolar lavage in immunocompromised patients.Chest,2012,142:187A.

1. Martin WJ 2nd,Smith TF,Sanderson DR,et al.Role of bronchoalveolar lavage in the assessment of opportunistic pulmonary infections:utility and complications.Mayo Clinic Proc,1987,62:549-557.
2. White P,Bonacum JT,Miller CB.Utility of fiberoptic bronchoscopy in bone marrow transplant patients.Bone Marrow Transplant,1997,20:681-687.
3. Patel NR,Lee PS,Kim JH,et al.The influence of diagnostic bronchoscopy on clinical outcomes comparing adult autologous and allogeneic bone marrow transplant patients.Chest,2005,127:1388-1396.
4. Stover DE,Zaman MB,Hajdu SI,et al.Bronchoalveolar lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host.Ann Intern Med,1984,101:1-7.
5. Feinstein MB,Mokhtari M,Ferreiro R,et al.Fiberoptic bronchoscopy in allogeneic bone marrow transplantation:findings in the era of serum cytomegalovirus antigen surveillance.Chest,2001,120:1094-1100.
6. Hummel M,Rudert S,Hof H,et al.Diagnostic yield of bronchoscopy with bronchoalveolar lavage in febrile patients with hematologic malignancies and pulmonary infiltrates.Ann Hematol,2008,87:291-297.
7. Rano A,Agusti C,Jimenez P,et al.Pulmonary infiltrates in non-HIV immunocompromised patients:a diagnostic approach using non-invasive and bronchoscopic procedures.Thorax,2001,56:379-387.
8. Eriksson BM,Dahl H,Wang FZ,et al.Diagnosis of pulmonary infections in immunocompromised patients by fiber-optic bronchoscopy with bronchoalveolar lavage and serology.Scand J Infect Dis,1996,28:479-485.
9. Dunagan DP,Baker AM,Hurd DD,et al.Bronchoscopic evaluation of pulmonary infiltrates following bone marrow transplantation.Chest,1997,111:135-141.
10. Huaringa AJ,Leyva FJ,Signes-Costa J,et al.Bronchoalveolar lavage in the diagnosis of pulmonary complications of bone marrow transplant patients.Bone Marrow Transplant,2000,25:975-979.
11. Velez L,Correa LT,Maya MA,et al.Diagnostic accuracy of bronchoalveolar lavage samples in immunosuppressed patients with suspected pneumonia:analysis of a protocol.Respir Med,2007,101:2160-2167.
12. Jain P,Sandur S,Meli Y,et al.Role of flexible bronchoscopy in immunocompromised patients with lung infiltrates.Chest,2004,125:712-722.
13. Brownback KR,Simpson SQ.Association of bronchoalveolar lavage yield with chest computed tomography findings and symptoms in immunocompromised patients.Ann Thorac Med,2013,8:153-159.
14. Gleckman RA,Czachor JS.Antibiotic side effects.Seminars Respir Critical Care Med,2000,21:53-60.
15. Brownback K,Simpson S.Factors affecting diagnostic yield of bronchoalveolar lavage in immunocompromised patients.Chest,2012,142:187A.

Chinese Journal of Respiratory and Critical Care Medicine

Diagnostic Yield of Bronchoscopy in Obtaining Microorganisms in Patients with Rheumatic Autoimmune Disease and Pulmonary Abnormality: Influencing Factors Analysis

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