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This Article Full Text (PDF) All Versions of this Article: chest.07-1948v1 133/1/226    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kinder, B. W. Articles by King, T. E. Search for Related Content PubMed PubMed Citation Articles by Kinder, B. W. Articles by King, T. E., Jr.

BASELINE BRONCHOALVEOLAR LAVAGE NEUTROPHILIA PREDICTS EARLY MORTALITY IN IDIOPATHIC PULMONARY FIBROSIS

¹Department of Medicine at the University of Cincinnati College of Medicine, Cincinnati, OH ²Department of Medicine at the National Jewish Medical and Research Center and the University of Colorado at Denver Health Sciences Center ³Department of Medicine at the University of California, San Diego; San Diego, CA and ⁴Department of Medicine at the University of California, San Francisco School of Medicine; San Francisco, CA

Abstract

BACKGROUND: The prognostic value of bronchoalveolar lavage (BAL) cell count differential in patients with idiopathic pulmonary fibrosis (IPF) is unknown. We hypothesized that baseline BAL cell count differential (elevated neutrophils and eosinophils, or reduced lymphocytes) would predict higher mortality among persons with IPF.

METHODS: We evaluated the association of BAL cell count differential and mortality among 156 persons with surgical lung biopsy proven IPF who underwent bronchoscopy with BAL and cell count differentials at presentation. Vital status was obtained among all participants. Cox regression analysis evaluated the association of BAL cell count differential and mortality.

RESULTS: After controlling for known clinical predictors of mortality, we found that each doubling of baseline BAL neutrophil percentage was associated with a 30 percent increased risk of mortality (adjusted hazard ratio [HR] 1.28; 95% confidence interval [CI] 1.01 to 1.62; adjusted P = 0.04) in the first year after presentation. We observed no association with BAL lymphocyte percentage and mortality (adjusted HR per doubling =0.99; 95% CI 0.76 to 1.29; P = 0.93) or eosinophil percentage and mortality (adjusted HR per doubling = 0.99; 95% CI 0.69 to 1.40; P = 0.95).

CONCLUSIONS: Increased BAL neutrophil percentage is an independent predictor of early mortality among persons with IPF. Alternatively, BAL lymphocyte and eosinophil percentages were not associated with mortality. The clinical utility of BAL at the time of diagnosis of IPF should be re-considered.

Key Words: idiopathic pulmonary fibrosis • bronchoalveolar lavage • usual interstitial pneumonia • prospective studies • pulmonary fibrosis • smoking • physiopathology • survival rate • neutrophilia