A retrospective cohort study to investigate the diagnostic yield of bronchoscopy with bronchoalveolar lavage in highly immunocompromised adult patients

<b>Introduction:</b> Lung infections are associated with a high mortality rate in immunocompromised patients. Achieving an accurate and rapid diagnosis is vital to help guide the management thus improving survival. <b>Aims and objectives:</b> To establish the diagnostic yield, clinical value, and safety of bronchoscopy with bronchoalveolar lavage (BAL) in a mixed group of highly immunocompromised adult patients with pulmonary infiltrates. <b>Methods:</b> Medical notes from immunocompromised patients underwent bronchoscopy at King Fahad Specialist Hospital-Dammam were reviewed retrospectively (n=103, mean age 44.5yr, 62 males). Clinically significant findings of BAL were defined as a positive microbiological result of a potential pathogen, determined using routine culture, AFB stain, mycobacterial culture, Tb PCR, fungal culture, Aspergillus antigen, and multiplex PCR panel, and/or positive cytology. <b>Results:</b> The diagnostic yield of bronchoscopy with BAL was 52.4% (95%CI:42.6-62.2%). In a multiple logistic regression model, positive BAL was predicted by symptom of sputum (aOR=4.07, 95%CI:1.29–12.88, p=.02) and negative BAL was predicted by antiviral treatment (aOR=0.37, 95%CI:0.14–0.96, p=.04). Almost half of the procedures (n=45, 43.7%, 95%CI:33.9–53.4%) resulted in a change in the management plan, with BAL-positive findings more than twice as likely to result in a change (OR=2.39, 95%CI:1.07–5.33,p=.03). Only 3 (2.9%) procedures resulted in complications (ventilator support/oxygen escalation). <b>Conclusion:</b> BAL is useful and safe clinical tool resulting in changes in management in a significant proportion of immunocompromised patients with pulmonary infilterate