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Bauer, PR; Chevret, S; Yadav, H; Mehta, S; Pickkers, P; Bukan, RB; Rello, J; van de Louw, A; Klouche, K; Meert, AP; Martin-Loeches, I; Marsh, B; Socias Crespi, L; Moreno-Gonzalez, G; Buchtele, N; Amrein, K; Balik, M; Antonelli, M; Nyunga, M; Barratt-Due, A; Bergmans, DCJJ; Spoelstra-de Man, AME; Kuitunen, A; Wallet, F; Seguin, A; Metaxa, V; Lemiale, V; Burghi, G; Demoule, A; Karvunidis, T; Cotoia, A; Klepstad, P; Møller, AM; Mokart, D; Azoulay, E; Efraim investigators and the Nine-I study group.
Diagnosis and Outcome of Acute Respiratory Failure in Immunocompromised after Bronchoscopy.
Eur Respir J. 2019; 1802442 Doi: 10.1183/13993003.02442-2018
Web of Science PubMed FullText FullText_MUG

Co-Autor*innen der Med Uni Graz: Amrein Karin
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Abstract:: What are the use, diagnostic capability and outcomes of bronchoscopy added to non-invasive testing in immunocompromised patients? In this setting, an inability to identify the cause of acute hypoxemic respiratory failure is associated with worse outcome. Every effort should be made to obtain a diagnosis, either with non-invasive testing alone or combined with bronchoscopy. However, our understanding of the risks and benefits of bronchoscopy remains uncertain. This was a pre-planned secondary analysis of Efraim, a prospective, multinational, observational study of 1611 immunocompromised patients with acute respiratory failure admitted to ICU. We compared patients with non-invasive testing only to those who had also bronchoscopy by bivariate analysis and after propensity score matching. Bronchoscopy was performed in 618 (39%) patients who were more likely to have hematologic malignancy and a higher severity of illness score. Bronchoscopy alone achieved a diagnosis in 165 patients (27% adjusted diagnostic yield). Bronchoscopy resulted in a management change in 236 patients (38% therapeutic yield). Bronchoscopy was associated with worsening of respiratory status in 69 (11%) of patients. Bronchoscopy was associated with higher ICU (40 versus 28%, p<0.0001) and hospital mortality (49 versus 41%, p=0.003). The overall rate of undiagnosed causes was 13%. After propensity score matching, bronchoscopy remained associated with increased risk of hospital mortality (odds ratio 1.41, 95% confidence interval 1.08-1.81). Bronchoscopy was associated with improved diagnosis and changes in management but also increased hospital mortality. Balancing risk and benefit in individualised cases should be investigated further. Copyright ©ERS 2019.