Journal Article

Bronchoalveolar lavage fluid characteristics and outcomes of invasively mechanically ventilated patients with COVID-19 pneumonia in Genoa, Italy

Mastracci, Luca, Mora, Sara, De Maria, Andrea, Brunetti, Iole, Vena, Antonio, Sepulcri, Chiara, Bassetti, Matteo, Pincino, Rachele, Frisoni, Paolo, Mikulska, Malgorzata, Patroniti, Nicolò, Di Biagio, Antonio, Mangerini, Rosa, Icardi, Giancarlo, Orsi, Andrea, Dentone, Chiara, Grillo, Federica, Gratarola, Angelo, Giacobbe, Daniele Roberto, Tedone, Elisabetta, Delfino, Emanuele, Bruzzone, Bianca, Pelosi, Paolo, Ball, Lorenzo, Barisione, Emanuela, Nicolini, Laura, Cerchiaro, Matteo, Loconte, Maurizio, Bavastro, Martina, Taramasso, Lucia, Magnasco, Laura

2021

Overview

Background The primary objective of the study is to describe the cellular characteristics of bronchoalveolar lavage fluid (BALF) of COVID-19 patients requiring invasive mechanical ventilation; the secondary outcome is to describe BALF findings between survivors vs non-survivors. Materials and methods Patients positive for SARS-CoV-2 RT PCR, admitted to ICU between March and April 2020 were enrolled. At ICU admission, BALF were analyzed by flow cytometry. Univariate, multivariate and Spearman correlation analyses were performed. Results Sixty-four patients were enrolled, median age of 64 years (IQR 58–69). The majority cells in the BALF were neutrophils (70%, IQR 37.5–90.5) and macrophages (27%, IQR 7–49) while a minority were lymphocytes, 1%, TCD3+ 92% (IQR 82–95). The ICU mortality was 32.8%. Non-survivors had a significantly older age ( p  = 0.033) and peripheral lymphocytes ( p  = 0.012) were lower compared to the survivors. At multivariate analysis the percentage of macrophages in the BALF correlated with poor outcome (OR 1.336, CI95% 1.014–1.759, p  = 0.039). Conclusions In critically ill patients, BALF cellularity is mainly composed of neutrophils and macrophages. The macrophages percentage in the BALF at ICU admittance correlated with higher ICU mortality. The lack of lymphocytes in BALF could partly explain a reduced anti-viral response.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Aged / Alveoli / Antiviral agents / Antiviral drugs / Artificial respiration / Bacterial pneumonia / Bronchoalveolar lavage / Bronchoalveolar lavage fluid / Bronchoalveolar Lavage Fluid - cytology / Bronchoalveolar Lavage Fluid - immunology / Bronchoalveolar Lavage Fluid - virology / Bronchus / Care and treatment / Coronaviruses / Correlation analysis / COVID-19 / COVID-19 - epidemiology / COVID-19 - immunology / COVID-19 - mortality / COVID-19 - virology / Critical Illness - epidemiology / Critically ill / Electrical impedance / Female / Flow cytometry / Humans / Infectious Diseases / Intensive Care Units / Internal Medicine / Italy - epidemiology / Lavage / Leukocyte Count / Leukocytes (neutrophilic) / Lymphocytes / Lymphocytes - cytology / Macrophages / Macrophages - cytology / Male / Mechanical ventilation / Medical examination / Medical Microbiology / Medicine / Medicine & Public Health / Middle Aged / Mortality / Multivariate analysis / Neutrophils - cytology / Parasitology / Patient outcomes / Pneumonia / Pneumonia, Viral - epidemiology / Pneumonia, Viral - immunology / Pneumonia, Viral - mortality / Pneumonia, Viral - virology / Research Article / Respiration, Artificial / SARS-CoV-2 - immunology / SARS-CoV-2 - pathogenicity / Severe acute respiratory syndrome coronavirus 2 / Survival / Survivors - statistics & numerical data / Treatment Outcome / Tropical Medicine / Ventilation / Viral infections