Diagnosis and outcome of acute respiratory failure in immunocompromised patients after bronchoscopy

Efraim investigators and the Nine-I study group

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVE: We wished to explore the use, diagnostic capability and outcomes of bronchoscopy added to noninvasive testing in immunocompromised patients. In this setting, an inability to identify the cause of acute hypoxaemic respiratory failure is associated with worse outcome. Every effort should be made to obtain a diagnosis, either with noninvasive testing alone or combined with bronchoscopy. However, our understanding of the risks and benefits of bronchoscopy remains uncertain. PATIENTS AND METHODS: This was a pre-planned secondary analysis of Efraim, a prospective, multinational, observational study of 1611 immunocompromised patients with acute respiratory failure admitted to the intensive care unit (ICU). We compared patients with noninvasive testing only to those who had also received bronchoscopy by bivariate analysis and after propensity score matching. RESULTS: Bronchoscopy was performed in 618 (39%) patients who were more likely to have haematological 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%) 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 (OR 1.41, 95% CI 1.08-1.81). CONCLUSIONS: 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.
Original languageEnglish
JournalEuropean Respiratory Journal
Volume54
Issue number1
DOIs
Publication statusPublished - 2019

Cite this

@article{6796aaa4985b4116ae14e1b15425b089,
title = "Diagnosis and outcome of acute respiratory failure in immunocompromised patients after bronchoscopy",
abstract = "OBJECTIVE: We wished to explore the use, diagnostic capability and outcomes of bronchoscopy added to noninvasive testing in immunocompromised patients. In this setting, an inability to identify the cause of acute hypoxaemic respiratory failure is associated with worse outcome. Every effort should be made to obtain a diagnosis, either with noninvasive testing alone or combined with bronchoscopy. However, our understanding of the risks and benefits of bronchoscopy remains uncertain. PATIENTS AND METHODS: This was a pre-planned secondary analysis of Efraim, a prospective, multinational, observational study of 1611 immunocompromised patients with acute respiratory failure admitted to the intensive care unit (ICU). We compared patients with noninvasive testing only to those who had also received bronchoscopy by bivariate analysis and after propensity score matching. RESULTS: Bronchoscopy was performed in 618 (39{\%}) patients who were more likely to have haematological 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{\%}) 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 (OR 1.41, 95{\%} CI 1.08-1.81). CONCLUSIONS: 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.",
author = "{Efraim investigators and the Nine-I study group} and Bauer, {Philippe R.} and Sylvie Chevret and Hemang Yadav and Sangeeta Mehta and Peter Pickkers and Bukan, {Ramin B.} and Jordi Rello and {van de Louw}, Andry and Kada Klouche and Anne-Pascale Meert and Ignacio Martin-Loeches and Brian Marsh and {Socias Crespi}, Lorenzo and Gabriel Moreno-Gonzalez and Nina Buchtele and Karin Amrein and Martin Balik and Massimo Antonelli and Martine Nyunga and Andreas Barratt-Due and Bergmans, {Dennis C. J. J.} and {Spoelstra-de Man}, {Ang{\'e}lique M. E.} and Anne Kuitunen and Florent Wallet and Amelie Seguin and Victoria Metaxa and Virginie Lemiale and Gaston Burghi and Alexandre Demoule and Thomas Karvunidis and Antonella Cotoia and Klepstad, {P. l} and M{\o}ller, {Ann M.} and Djamel Mokart and Elie Azoulay",
year = "2019",
doi = "10.1183/13993003.02442-2018",
language = "English",
volume = "54",
journal = "European Respiratory Journal",
issn = "0903-1936",
publisher = "European Respiratory Society",
number = "1",

}

Diagnosis and outcome of acute respiratory failure in immunocompromised patients after bronchoscopy. / Efraim investigators and the Nine-I study group.

In: European Respiratory Journal, Vol. 54, No. 1, 2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Diagnosis and outcome of acute respiratory failure in immunocompromised patients after bronchoscopy

AU - Efraim investigators and the Nine-I study group

AU - Bauer, Philippe R.

AU - Chevret, Sylvie

AU - Yadav, Hemang

AU - Mehta, Sangeeta

AU - Pickkers, Peter

AU - Bukan, Ramin B.

AU - Rello, Jordi

AU - van de Louw, Andry

AU - Klouche, Kada

AU - Meert, Anne-Pascale

AU - Martin-Loeches, Ignacio

AU - Marsh, Brian

AU - Socias Crespi, Lorenzo

AU - Moreno-Gonzalez, Gabriel

AU - Buchtele, Nina

AU - Amrein, Karin

AU - Balik, Martin

AU - Antonelli, Massimo

AU - Nyunga, Martine

AU - Barratt-Due, Andreas

AU - Bergmans, Dennis C. J. J.

AU - Spoelstra-de Man, Angélique M. E.

AU - Kuitunen, Anne

AU - Wallet, Florent

AU - Seguin, Amelie

AU - Metaxa, Victoria

AU - Lemiale, Virginie

AU - Burghi, Gaston

AU - Demoule, Alexandre

AU - Karvunidis, Thomas

AU - Cotoia, Antonella

AU - Klepstad, P. l

AU - Møller, Ann M.

AU - Mokart, Djamel

AU - Azoulay, Elie

PY - 2019

Y1 - 2019

N2 - OBJECTIVE: We wished to explore the use, diagnostic capability and outcomes of bronchoscopy added to noninvasive testing in immunocompromised patients. In this setting, an inability to identify the cause of acute hypoxaemic respiratory failure is associated with worse outcome. Every effort should be made to obtain a diagnosis, either with noninvasive testing alone or combined with bronchoscopy. However, our understanding of the risks and benefits of bronchoscopy remains uncertain. PATIENTS AND METHODS: This was a pre-planned secondary analysis of Efraim, a prospective, multinational, observational study of 1611 immunocompromised patients with acute respiratory failure admitted to the intensive care unit (ICU). We compared patients with noninvasive testing only to those who had also received bronchoscopy by bivariate analysis and after propensity score matching. RESULTS: Bronchoscopy was performed in 618 (39%) patients who were more likely to have haematological 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%) 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 (OR 1.41, 95% CI 1.08-1.81). CONCLUSIONS: 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.

AB - OBJECTIVE: We wished to explore the use, diagnostic capability and outcomes of bronchoscopy added to noninvasive testing in immunocompromised patients. In this setting, an inability to identify the cause of acute hypoxaemic respiratory failure is associated with worse outcome. Every effort should be made to obtain a diagnosis, either with noninvasive testing alone or combined with bronchoscopy. However, our understanding of the risks and benefits of bronchoscopy remains uncertain. PATIENTS AND METHODS: This was a pre-planned secondary analysis of Efraim, a prospective, multinational, observational study of 1611 immunocompromised patients with acute respiratory failure admitted to the intensive care unit (ICU). We compared patients with noninvasive testing only to those who had also received bronchoscopy by bivariate analysis and after propensity score matching. RESULTS: Bronchoscopy was performed in 618 (39%) patients who were more likely to have haematological 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%) 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 (OR 1.41, 95% CI 1.08-1.81). CONCLUSIONS: 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.

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85070658740&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/31109985

U2 - 10.1183/13993003.02442-2018

DO - 10.1183/13993003.02442-2018

M3 - Article

VL - 54

JO - European Respiratory Journal

JF - European Respiratory Journal

SN - 0903-1936

IS - 1

ER -