Baseline BAL neutrophilia predicts early mortality in idiopathic pulmonary fibrosis
Baseline BAL neutrophilia predicts early mortality in idiopathic pulmonary fibrosis
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DOI：
10.1378/chest.07-1948
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发表时间：
2008-01-01
期刊：
影响因子：
9.6
通讯作者：
King, Talmadge E., Jr.
中科院分区：
文献类型：
--
作者：
Kinder, Brent W.;Brown, Kevin K.;King, Talmadge E., Jr.
背景：BAL液细胞计数差异对特发性肺纤维化（IPF）患者的预后价值尚不清楚。我们假设基线BAL液细胞计数差异（即中性粒细胞和嗜酸性粒细胞水平升高，或淋巴细胞水平降低）可以预测IPF患者较高的死亡率。方法：我们评估了156例手术肺活检证实的IPF患者的BAL液细胞计数差异与死亡率的关系，这些患者在就诊时接受了BAL支气管镜检查和细胞计数差异测量。在所有参与者中获得重要状态。Cox回归分析评估BAL液细胞计数差异与死亡率的关系。结果：在控制已知的临床死亡预测因子后，我们发现，在就诊后的第一年，基线BAL液中性粒细胞百分比每增加一倍，死亡风险增加30%（校正风险比[HR]， 1.28； 95%置信区间[CI]， 1.01至1.62；校正p = 0.04）。我们观察到BAL液淋巴细胞百分比和死亡率（每翻倍调整HR， 0.99; 95% CI， 0.76至1.29;p = 0.93）或嗜酸性粒细胞百分比和死亡率（每翻倍调整HR， 0.99; 95% CI， 0.69至1.40;p = 0.95）无关联。结论：BAL液中性粒细胞百分比升高是IPF患者早期死亡的独立预测因子。另外，BAL液淋巴细胞和嗜酸性粒细胞百分比与死亡率无关。在诊断IPF时，应重新考虑BAIL的临床应用。
Background: The prognostic value of BAL fluid cell count differential in patients with idiopathic pulmonary fibrosis (IPF) is unknown. We hypothesized that baseline BAL fluid cell count differential (ie, elevated levels of neutrophils and eosinophils, or reduced levels of lymphocytes) would predict higher mortality among persons with IPF.Methods: We evaluated the association of BAL fluid cell count differential and mortality among 156 persons with surgical lung biopsy-proven IPF who underwent bronchoscopy with BAL and cell count differential measurements at presentation. Vital status was obtained among all participants. Cox regression analysis evaluated the association of BAL fluid cell count: differential and mortality.Results: After controlling for known clinical predictors of mortality, we found that each doubling of baseline BAL fluid neutrophil percentage was associated with a 30% 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 fluid 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 fluid neutrophil percentage is an independent predictor of early-mortality among persons with IPF. Alternatively, BAL fluid lymphocyte and eosinophil percentages were not associated with mortality. The clinical utility of BAIL, at the time of diagnosis of IPF should be reconsidered.