Chest
Volume 133, Issue 1, January 2008, Pages 226-232
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Original Research
IDIOPATHIC PULMONARY FIBROSIS
Baseline BAL Neutrophilia Predicts Early Mortality in Idiopathic Pulmonary Fibrosis

https://doi.org/10.1378/chest.07-1948Get rights and content

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 BAL at the time of diagnosis of IPF should be reconsidered.

Section snippets

Study Subjects

The study cohort consisted of 156 patients with IPF who were prospectively enrolled into a Specialized Center of Research Study at the National Jewish Medical and Research Center between 1982 and 1996. The diagnosis of IPF was made based on established clinical and histologic criteria, as described previously.10 The inclusion and exclusion criteria have been previously reported.10 At the initial visit, all participants underwent clinical, radiographic, and physiologic assessments before

Subject Characteristics

The IPF study cohort included 156 subjects (mean age, 63 years; 66% were men; and 88% were white) [Table 1]. Sixty-seven percent of the cohort were either current or former smokers. At the time of the initial visit, the median duration of illness was 24 months. There were 139 participants censored due to death during the study period (89%). In 10 patients, censoring occurred at the time of transplantation. Six patients (4%) were administratively censored because they were alive at the time of

Discussion

This study examined the association of BAL fluid cellular constituents with survival in a large, well-characterized cohort of IPF patients with long-term and comprehensive follow-up. The data demonstrate that, among persons with IPF, BAL fluid neutrophil percentage obtained at the time of initial diagnosis is an independent predictor of time to death or transplant. The impact was most dramatic in the first year of follow-up and attenuated with time. This association remained essentially

ACKNOWLEDGMENT

The authors are grateful to Eric Vittinghoff for his help with the statistical analysis; to Thomas V. Colby, James A. Waldron, Jr, Andrew Flint, Carlyne Cool, and Rubin M. Tuder, for their pathological reviews; to Reuben M. Cherniack, Leslie C. Watters, Thaddeus L. Dunn, Anthony Shen, Rebecca L. Mortenson, John Wade, and Eugene Sullivan for their role in enrolling patients; to S. Arlene Niccoli, and Martin Wallace for their expert technical assistance in the laboratory; and to the referring

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    This research was supported by a National Institutes of Health T32 training grant, a Clinical Research Loan Repayment Grant, and Specialized Center of Research (SCOR) grants No. HL-27353 and HL-67671 from the National Heart, Lung, and Blood Institute.

    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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