Abstract
BackgroundThe 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.MethodsBAL 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.ResultsBacterial 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.ConclusionsCellular analysis of BAL fluid can aid early differential diagnosis of bacterial pneumonia from viral pneumonia in critically ill patients.
Highlights
Severe pneumonia requiring intensive care unit (ICU) admission is associated with high rates of morbidity and mortality
Such analysis would be useful for guiding early treatment if it could predict the etiology of pneumonia, similar to the role of cerebrospinal fluid cellular analysis, which can reliably differentiate among meningitis etiologies
This study investigated whether analysis of the cellular profile of bronchoalveolar lavage (BAL) fluid can predict the etiology of pneumonia in critically ill patients admitted to the medical ICU
Summary
Severe pneumonia requiring intensive care unit (ICU) admission is associated with high rates of morbidity and mortality. Only a few previous studies with limited patient populations [11,12,13] have evaluated the role of cellular analysis of BAL fluid in patients with suspected pneumonia. Most of these studies focused on the differential diagnosis of pneumonia from non-infectious pulmonary diseases, not on the prediction of pneumonia etiology. 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
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