title: Prognostic value of bronchoalveolar lavage in patients with non-HIV pneumocystis pneumonia.
abstract: OBJECTIVE
  Non-HIV patients with pneumocystis pneumonia (PCP) have a poor prognosis. We aimed to evaluate the prognostic factors for in-hospital mortality in terms of the clinical findings, including the results of bronchoalveolar lavage fluid (BALF)-analyses, in non-HIV PCP patients.
  
  
  METHODS
  We retrospectively reviewed non-HIV PCP patients diagnosed using bronchoalveolar lavage between April 2006 and July 2012. For patients with a poor respiratory status, noninvasive positive pressure ventilation (NPPV) was used during the bronchoalveolar lavage (BAL) procedure. Data regarding demographics, laboratory findings and the prognosis were evaluated.
  
  
  RESULTS
  A total of 29 non-HIV PCP patients were analyzed. NPPV was carried out safely and successfully in 12 patients during the BAL procedure. Twelve patients (41%) died. The multivariate logistic regression analysis identified only BALF neutrophilia to be a significant prognostic factor determining in-hospital mortality. The log-rank test showed that the patients with BALF neutrophilia (≥ 31%) had a significantly lower survival rate than the other patients (p=0.001).
  
  
  CONCLUSIONS
  Only BALF neutrophilia was found to be a significant predictor of survival in patients with non-HIV PCP. Our data also emphasize the significance of performing BAL in such patients, as it provides both diagnostic and prognostic information.
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Tamai
authors.forename: Ryo
authors.initials: R
authors.lastname: Tachikawa
authors.forename: Keisuke
authors.initials: K
authors.lastname: Tomii
authors.forename: Kazuma
authors.initials: K
authors.lastname: Nagata
authors.forename: Kojiro
authors.initials: K
authors.lastname: Otsuka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakagawa
authors.forename: Kyoko
authors.initials: K
authors.lastname: Otsuka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Kazuya
authors.initials: K
authors.lastname: Monden
authors.forename: Jumpei
authors.initials: J
authors.lastname: Takeshita
authors.forename: Kosuke
authors.initials: K
authors.lastname: Tanaka
authors.forename: Takahisa
authors.initials: T
authors.lastname: Kawamura
authors.forename: Takehiro
authors.initials: T
authors.lastname: Otoshi
authors.forename: Daichi
authors.initials: D
authors.lastname: Fujimoto
mesh_terms: D000328:Adult; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology* / Q000382:microbiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D045363:Pneumocystis carinii / Q000302:isolation & purification*; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis / Q000401:mortality; D011175:Positive-Pressure Respiration; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate